@article{365fcbb5e0504ce58c32984ed6d144f9,
title = "Safety of the transradial approach to carotid stenting",
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.",
keywords = "carotid artery disease, cerebrovascular disease, intervention, interventional devices/innovation, stenting, stroke, technique",
author = "Young Erben and Meschia, {James F.} and Heck, {Donald V.} and Shawl, {Fayaz A.} and Minerva Mayorga-Carlin and George Howard and Kenneth Rosenfield and Sorkin, {John D.} and Brott, {Thomas G.} and Lal, {Brajesh K.}",
note = "Funding Information: CREST-2 is funded by the National Institute of Neurological Disorders and Stroke through two U01 awards: U01 NS090168 and U01 NS08016, CREST-2 Registry is funded by the NINDS-NIH and by Abbott Vascular, Boston Scientific, Cordis-Cardinal, W. L. Gore and Associates, Medtronic and Silk Road Medical. The CREST-2 trials are supported by cooperative agreements U01 NS080168, and U01 NS080165 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, and by the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services. Additional support for CREST-2 comes from StrokeNet U01 NS086872. The C2R is supported by CMS, with additional support from Industry (Abbott Vascular, Boston Scientific, Cardinal Health, Covidien, Gore Medical and Silk Road Medical). The authors thank the other investigators, the staff, and the participants of the CREST-2 trials for their valuable contributions. A full list of participating CREST-2 investigators and institutions can be found at http://www.crest2trial.org. Funding Information: CREST‐2 is funded by the National Institute of Neurological Disorders and Stroke through two U01 awards: U01 NS090168 and U01 NS08016, CREST‐2 Registry is funded by the NINDS‐NIH and by Abbott Vascular, Boston Scientific, Cordis‐Cardinal, W. L. Gore and Associates, Medtronic and Silk Road Medical. Funding Information: The CREST‐2 trials are supported by cooperative agreements U01 NS080168, and U01 NS080165 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, and by the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services. Additional support for CREST‐2 comes from StrokeNet U01 NS086872. The C2R is supported by CMS, with additional support from Industry (Abbott Vascular, Boston Scientific, Cardinal Health, Covidien, Gore Medical and Silk Road Medical). The authors thank the other investigators, the staff, and the participants of the CREST‐2 trials for their valuable contributions. A full list of participating CREST‐2 investigators and institutions can be found at http://www.crest2trial.org . Publisher Copyright: {\textcopyright} 2021 Wiley Periodicals LLC.",
year = "2022",
month = feb,
day = "15",
doi = "10.1002/ccd.29912",
language = "English (US)",
volume = "99",
pages = "814--821",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",
number = "3",
}