• Daisuke Sato, Motoyuki Umekawa, Satoshi Koizumi, Daiichiro Ishigami, Satoshi Kiyofuji, and Nobuhito Saito.
• Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
• World Neurosurg. 2024 Mar 1; 183: e920e927e920-e927.

BackgroundTranscarotid artery revascularization (TCAR) has emerged as an alternative to carotid artery stenting (CAS). TCAR demonstrated its superiority by avoiding femoral artery puncture and establishing proximal protection without crossing the stenotic lesion. In the TCAR era, we focused on the possibility of a trans-distal radial approach (DRA). A balloon-guide catheter was navigated via DRA to establish proximal protection before lesion crossing. The forearm subcutaneous vein was used as the flow-reversal circuit.MethodsSix internal carotid artery stenosis patients underwent CAS using "the forearm flow reversal technique." Every procedure was performed under continuous flow reversal from the common carotid artery to the forearm cephalic vein.ResultsSuccessful revascularization was achieved without ischemic or access-site complications. The distal radial artery was patent at discharge in all cases.ConclusionsTrans-distal radial CAS with forearm flow reversal is a feasible and less invasive technical option.Copyright © 2024 Elsevier Inc. All rights reserved.

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