Carotid artery stenting via a transbrachial artery: techniques and problems

Recently, carotid artery stenting (CAS) has been reported to be an alternative of carotid endarterectomy (CEA) for internal carotid artery (ICA) stenosis due to the improvement of protection devices. In general, the transfemoral approach has been chosen for CAS because of the sizes of the devices. However, the transfemoral route seems to be unavailable or at high risk, in cases of severe atherosclerotic changes or aneurysm of the femoral, iliac artery or aorta, or after bypass graft placement. In this report, we presented 5 patients who underwent CAS using the transbrachial approach. The mean stenotic rate of 84% before treatment was reduced to 14% after the procedures. The 30-day morbidity and mortality were both 0%. Major local complications at the puncture site were not encountered. There has been no stroke nor death during a mean follow-up period of 6 months. We suggest that CAS via transbrachial route is an effective and safe treatment for ICA stenosis, by use of low-profile devices and bi-plane DSA equipment, especially in patients who are not eligible for the transfemoral access.