• Shunsuke Tanoue, Kenichiro Ono, Terushige Toyooka, Masaya Nakagawa, and Kojiro Wada.
• Department of Neurosurgery, Mishuku Hospital, Tokyo, Japan; Department of Neurosurgery, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan. Electronic address: stanoue@ndmc.ac.jp.
• World Neurosurg. 2024 Jan 1; 181: e906e910e906-e910.

ObjectiveNeuroendovascular treatment via transradial access (TRA) has gained popularity as a minimally invasive technique. However, the flow reversal (FR) system, reported useful in carotid artery stenting (CAS), cannot be applied via TRA because it requires an access route of more than 8 F. Herein, we report the utility of a modified FR system applied via TRA using a sheathless 8-F balloon guide catheter and a 2.6-F balloon catheter.MethodsIn a retrospective analysis of a single-center consecutive case series, patients with CAS and vulnerable plaques who were treated with CAS via TRA using a modified FR system from June 2022 to August 2022 were examined. High-intensity spots were assessed on postprocedural diffusion-weighted magnetic resonance images. Puncture site complications at discharge and cardiovascular events for 1 year after CAS were also evaluated.ResultsTen patients were included in this study. There were no high-intensity spots on diffusion-weighted magnetic resonance images after CAS. No procedure-related complications, including radial artery occlusion or cardiovascular events, were observed.ConclusionsThis study suggests that CAS with FR using our modified system is feasible via TRA and may be an effective technique with a low rate of vascular complications.Copyright © 2023 Elsevier Inc. All rights reserved.

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