Abstract P516: A Comparison of Transradial and Transfemoral Approaches for Performance of Carotid Angioplasty and Stent Placement

Abstract

Context: Over the past few decades, transradial access has been increasingly utilized for neurointerventional procedures including carotid angioplasty and stent placement (CAS). Objective: To compare the outcomes of CAS performed via transradial approach with those performed using transfemoral approach within the same institution. Methods: We analyzed all the elective CAS procedures performed at our institute in the last 48 months and divided the procedures based on initial approach (transradial or transfemoral). Both approaches were used by same interventionalists to minimize inter-operator variability. We compared the rates of technical failure; hemorrhagic complications classified as major (hemoglobin decrease >5 g/dL or intracranial hemorrhage with deficits), minor (hemoglobin decreases 3-5 g/dL or intracranial hemorrhage without residual deficits), or insignificant; and any stroke and/or death within 1-month post procedure. Results: A total of 120 elective CAS procedures were performed at our institution; 84 patients (70%) were initiated as transfemoral and 36 patients (30%) were initiated as transradial approach. There were 6 (16%) CAS procedures initiated as trans-radial but later switched to transfemoral due to anatomical and/or technical difficulties. Similarly, 1(1.2%) procedure was switched to transradial from transfemoral. So finally, 89 (74%) patients had transfemoral approach and 31 (26%) patients had transradial approach to CAS. The median age was similar between the two groups (66.5 years versus 67.3 years).The rates of major hemorrhagic complications were 2 (2.2 %) and 0 (0%) in CAS performed using tranfemoral and tranradial approaches, respectively. The rate of any stroke and/or death within 30 days post procedure was 5 (5.6 %) and 1 (3.2 %) in CAS performed using transfemoral and transradial approaches, respectively.The median fluoroscopy time was 36.1 minutes and 34.4 minutes using transfemoral and transfemoral approaches, respectively (p =0.72). Conclusions: Transradial approach is comparable to transfemoral approach for performance of CAS in regard to clinical endpoints although the rates of technical failure remain relatively high in patients in whom CAS was initiated from transradial approach.