Learning curve of the transradial approach of percutaneous carotid intervention, EM Vegh

1. Eszter. M. Végh, B. Nemes, B. Teleki,
B. Merkely, K. Huttl, Z. Ruzsa
Learning curve of the transradial
approach of percutaneous carotid
intervention

2. • The authors have nothing to disclose.
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3. Introduction
• Stenting of internal carotid artery is a current treatment
option of patients with high risk of stroke. Transradial
approach became a novel alternative of conventional,
transfemoral intervention, as a
• Safe and
• Effective treatment option.
Ruzsa Z. et al: A randomised comparison of transradial and
transfemoral approach for carotid artery stenting: RADCAR
(RADial access for CARotid artery stenting) study.
EuroIntervention 2014
– Higher radiation dose was experienced at transradial, then
at transfemoral access.

4. Our aim
• Investigation of the transradial carotid
intervention learning curve in two
high-volume centers.
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Bács-Kiskun Megyei Kórház,
Kecskemét, Hungary
Heart and Vascular Center,
Semmelweis University,
Budapest, Hungary

5. Methods - Patients
In two centers, between 2010-2016/1:
1664 patients underwent carotid stenting.
Indication was:
• ≥ 70% stenosis, neurological symptoms, or
• significant stenosis, with or without symptoms.
549 patients transradial approach
Patient history, the parameters of the interventions were
registered prospectively.
Mean age: 67±9 years, 65% men, 88% HTN, 39% DM, 72% HLP.
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6. Methods – The intervention
• Local anesthetics (1% Lidocain)
• Intra-arterial 2.5 mg verapamil, 5,000 IU Na-heparin,
250 mcg nitroglycerin
• 4F sheath for diagnostics, later change for 6 or 7F
sheath
• Canulation and diagnostics with Simmonds catheter
• 7F guiding catheter or 6F guiding sheath
• Embolic protection filter was applied, then balloon post-
dilatation performed
• 6 hours compression on the puncture site.
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7. Results
99.8% success rate of interventions
8% femoral conversion – that ratio did not change
significantly during the years.
MACE: 6 cases
Major vascular event: 2 cases
Minor vascular event: 13 cases
Days of hospitalization: median 1 day in each year.
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8. Duration of the intervention
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(sec)
p=0.001
Independent samples median test
p=0.013

9. Duration of the fluoroscopy
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(sec)
p<0.001
Independent samples median test
p=0.020

10. Contrast material usage
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(ml)
ANOVA p=0.020
Independent samples median test
p<0.001
p=0.006

11. Duration of the fluoroscopy-
First 100 cases per center
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Independent samples median test
p<0.001

12. Usage of contrast material (ml) -
First 100 cases per center
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Independent samples median test
p = ns.

13. 13
p = 0.030
Independent samples median test
http://www.marmur.com/carotid-artery-stenting.html

14. Discussion
• Significant improvement in intervention and
radiation duration values, and contrast usage.
• After 50 cases, the irradiation became significantly
shorter.
• More complicated cases were done via transradial
approach with the growing experience (non-
significant difference in age, co-morbidities or
anatomy).
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15. Conclusion
The transradial carotid intervention can
be applied safely. The puncture
related complications are lower
compared to the femoral approach.
The transition to the transradial
approach can be performed in 2 year
in high-volume centers.
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