Transfemoral access (TFA) remains the standard approach for carotid artery stenting (CAS), although transradial and transbrachial access (TRA/TBA) are increasingly being explored to reduce vascular complications. A retrospective single-center analysis presented at EuroPCR 2026 compared procedural and long-term outcomes between radial and femoral access strategies for CAS.

The study included 2,060 consecutive CAS procedures performed between November 2000 and December 2025. Primary endpoints included 30-day major adverse cardiac and cerebrovascular events (MACCE) and major vascular complications. Secondary endpoints included procedural success, crossover rates, fluoroscopy time, radiation exposure, and 2-year event-free survival. Propensity-score matching and multivariable analyses were performed to adjust for baseline differences.

Among the cohort, 1,260 procedures were performed using TFA and 800 using TRA/TBA. Patients treated with radial access were older, more frequently categorized as high surgical risk, and less often symptomatic.

Findings

• Thirty-day MACCE rates were low and comparable between groups (2.39% with TFA vs 1.92% with TRA/TBA; adjusted odds ratio [OR] 0.86; 95% CI 0.45-1.93).
• Major vascular complications occurred less frequently with TRA/TBA (2.0% vs 3.9%; P = 0.017), although the difference was attenuated after propensity score adjustment (adjusted OR, 0.66; 95% CI, 0.37-1.28).
• Procedural success exceeded 99% with both access strategies.
• Access-site crossover was more frequent with TRA/TBA (1.9% vs 0.2%; P < 0.001).
• Fluoroscopy time was approximately 3 minutes longer with TRA/TBA when proximal protection was used, without a significant increase in radiation exposure.
• Event-free survival at 2 years exceeded 95% in both groups with no significant difference between strategies (log-rank P = 0.98).

TRA/TBA carotid artery stenting demonstrated similar short- and long-term outcomes to transfemoral access in this large real-world cohort. The findings support radial access as a feasible alternative approach with a potential reduction in vascular complications.