Brachial Artery Access for Carotid Artery Stenting: A Pooled Analysis

Introduction: In the realm of Carotid Artery Stenting (CAS), various access methods such as Transfemoral access (TFA), Transradial Artery access (TRA), and Transbrachial access (TBA) have been employed. While TFA is widely established, TRA and TBA offer alternative options. TBA lacks comprehensive studies, and there is a notable lack of comprehensive evidence systematically evaluating its outcomes.

Methods: This systematic review and meta-analysis aimed to comprehensively evaluate the safety and efficacy of TBA for CAS by conducting a thorough search on Medline, Cochrane Library, Embase, and Web of Science databases. Studies reporting TBA for CAS and evaluating primary outcomes such as good neurological results, procedural success, and complications were included. Studies with fewer than 4 patients were excluded.

Results: From 1837 studies initially found, eleven studies, involving 273 patients meeting our inclusion criteria, were comprehensively analyzed using the random effects model. The analysis of nine studies revealed a consistent 100% procedural success rate with minimal variability (95% CI: 98% to 100%, I² = 0%). In the final assessment of neurological status across eight studies, good neurological outcomes were observed in 99% (95% CI: 98% to 100%, I²= 0%). Additionally, nineteen complications were identified, leading to a 4% rate (95% CI: 0% to 9%, I² = 48%). Among the 223 patients in eight studies, there were no procedure-related deaths, resulting in a pooled estimate of 0% mortality (95% CI: 0% to 1%, I²= 0%), indicating a favorable safety profile.

Conclusion : The results of TBA for CAS demonstrate a highly effective and safe procedure. Despite the limitations, TBA can be an option in patients with no other access available, and further comparative studies are required to establish definitive conclusions.