Trans-distal radial artery carotid revascularization with forearm flow reversal: An alternative option of CAS in the TCAR era.

Transcarotid artery revascularization (TCAR) has emerged as an alternative to carotid artery stenting (CAS). TCAR demonstrated its superiority by avoiding femoral artery puncture and establishing proximal protection without crossing the stenotic lesion. In the TCAR era, we focused on the possibility of a transdistal radial approach (DRA). A balloon-guide catheter was navigated via DRA to establish proximal protection before lesion crossing. The forearm subcutaneous vein was used as the flow-reversal circuit. Six internal carotid artery stenosis patients underwent CAS using “the forearm flow reversal technique.” Every procedure was performed under continuous flow reversal from the common carotid artery to the forearm cephalic vein. Successful revascularization was achieved without ischemic or access-site complications. The distal radial artery was patent at discharge in all cases. Trans-distal radial CAS with forearm flow reversal is a feasible and less invasive technical option.