학술논문
Safety of the transradial approach to carotid stenting.
Document Type
Academic Journal
Author
Erben Y; Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida, USA.; Meschia JF; Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.; Heck DV; Department of Radiology, Novant Health Forsyth Radiological Associates and Triad Radiology Associates, Winston-Salem, North Carolina, USA.; Shawl FA; Department of Medicine, Washington Adventist/White Oak Medical Center, Silver Spring, Maryland, USA.; Mayorga-Carlin M; Department of Vascular Surgery, University of Maryland, Baltimore, Maryland, USA.; Howard G; Department of Biostatistics and Epidemiology, School of Public Health, University of Alabama, Birmingham, Alabama, USA.; Rosenfield K; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Sorkin JD; Baltimore VA Geriatrics Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA.; Department of Medicine, Division Gerontology and Geriatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Brott TG; Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.; Lal BK; Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.; Department of Vascular Surgery, University of Maryland, Baltimore, Maryland, USA.
Source
Publisher: Wiley-Liss Country of Publication: United States NLM ID: 100884139 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1522-726X (Electronic) Linking ISSN: 15221946 NLM ISO Abbreviation: Catheter Cardiovasc Interv Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The multicenter prospective CREST-2 Registry (C2R) provides recent experience in performing carotid artery stenting (CAS) for interventionists to ensure safe performance of CAS.
Objective: To determine the periprocedural safety of CAS performed using a transradial approach relative to CAS performed using a transfemoral approach.
Methods: Patients with ≥70% asymptomatic and ≥50% symptomatic carotid stenosis, ≤80 years of age and at standard or high risk for carotid endarterectomy (CEA) are eligible for the C2R. The primary endpoint was a composite of severe access-related complications. Comparisons were made using propensity-score matched logistic regression.
Results: The mean age of the cohort was 67.6 ± 8.2 years and 1906 (35.1%) were female. Indications for CAS included 4063 (74.9%) for primary atherosclerosis. A total of 2868 (52.8%) cases underwent CAS for asymptomatic disease. Transradial access was used in 213 (3.9%) patients. The transradial cohort had lower use of general anesthesia (1.5% vs. 6.3%, p = 0.007) and higher use of distal embolic protection (96.7% vs. 89.4%, p = 0.0004). There were no significant differences between radial and femoral access groups in terms of a composite of major access-related complications (0% vs. 1.1%) or a composite of periprocedural stroke or death (3.3% vs. 2.4%; OR = 1.4 [confidence intervals 0.6, 3.1]; p = 0.42).
Conclusion: We found no significant differences in rates of major access-related complications or periprocedural stroke or death with CAS performed using transradial compared to transfemoral access. Our results support incorporation of the transradial approach to clinical trials comparing CAS to other revascularization techniques.
(© 2021 Wiley Periodicals LLC.)
Objective: To determine the periprocedural safety of CAS performed using a transradial approach relative to CAS performed using a transfemoral approach.
Methods: Patients with ≥70% asymptomatic and ≥50% symptomatic carotid stenosis, ≤80 years of age and at standard or high risk for carotid endarterectomy (CEA) are eligible for the C2R. The primary endpoint was a composite of severe access-related complications. Comparisons were made using propensity-score matched logistic regression.
Results: The mean age of the cohort was 67.6 ± 8.2 years and 1906 (35.1%) were female. Indications for CAS included 4063 (74.9%) for primary atherosclerosis. A total of 2868 (52.8%) cases underwent CAS for asymptomatic disease. Transradial access was used in 213 (3.9%) patients. The transradial cohort had lower use of general anesthesia (1.5% vs. 6.3%, p = 0.007) and higher use of distal embolic protection (96.7% vs. 89.4%, p = 0.0004). There were no significant differences between radial and femoral access groups in terms of a composite of major access-related complications (0% vs. 1.1%) or a composite of periprocedural stroke or death (3.3% vs. 2.4%; OR = 1.4 [confidence intervals 0.6, 3.1]; p = 0.42).
Conclusion: We found no significant differences in rates of major access-related complications or periprocedural stroke or death with CAS performed using transradial compared to transfemoral access. Our results support incorporation of the transradial approach to clinical trials comparing CAS to other revascularization techniques.
(© 2021 Wiley Periodicals LLC.)