Transbrachial carotid artery stenting with novel sheath guide is feasible and safe

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Takahisa Mori, Shonan Kamakura General Hospital Stroke Center, Kamakura City, Kanagawa, Japan, and colleagues reported on their first experience of transbrachial carotid artery stenting using a novel sheath guide in the Journal of NeuroInterventional Surgery

Mori et al said: “previous studies have reported that transbrachial carotid artery stenting is effective in cases unsuitable for transfemoral carotid artery stenting due to aortic and peripheral arterial conditions.” They also stated that, previous to their study, there were no sheath guides specially made for the transbrachial approach but a guide designed for this approach had become commercially available, therefore the authors aimed to report on their initial experiences with the novel sheath for transbrachial carotid cannulation and its effectiveness as an alternative to transfemoral carotid artery stenting.

Mori said: “I expected to perform transbrachial treatment safely and reliably before I developed the novel sheath guide jointly with Medikit Japan a few years ago.”


Mori and colleagues evaluated results respectively of patients who underwent transbrachial carotid artery stenting between May 2011 and July 2012.


Technique


The guide that was used, according to the authors, was the MSK-guide 7.5×90 (Medikit) which was reported to have a U-shape specifically designed for transbrachial carotid cannulation. The authors positioned the MSK-guide in the ascending aorta with the coaxial technique which consisted of a 5F outside diameter catheter of 130cm length (Medikit) and introduced directly into the affected common carotid artery. The authors reported activated clotting time became shorter than 150s. The sheath guide was then removed and haemostasis was obtained by manual compression.


Mori and others evaluated the success of the procedure retrospectively. Of the 70 patients included in the study seven underwent non-elective emergency carotid artery stenting and 63 underwent elective carotid artery stenting. Of the 62 patients included in the study 17 had type I, 22 had type II and 23 had type III aortic arch type. According to the authors the patients had high-grade carotid stenosis and the operators had no problems using the right brachial artery as an access route.


“We were successful in carotid artery cannulation in a similar way to manipulation of a diagnostic catheter and stent deployment was successful in all 62 cases,” said Mori and others. “Our results suggest that transbrachial carotid artery stenting with the sheath guide specifically designed for transbrachial carotid artery cannulation is feasible and safe.”

However, the authors said: “Because of the small number of cases in the present study, a larger number of cases are required to confirm our results.”

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