Distal radial artery (snuffbox) access for carotid artery stenting - Technical pearls and procedural set-up

UMMS Affiliation

Division of Neurointerventional Radiology, Department of Radiology

Publication Date


Document Type



Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Neurology | Radiology


PURPOSE: To report use of distal radial artery (dRA) access for carotid artery stenting (CAS) and to discuss procedural setup and technical considerations for a successful intervention.

METHODS: A retrospective review of our prospective neurointerventional database of CAS was conducted between May 2019 and March 2020. All CAS cases via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data was collected.

RESULTS: 22 CAS procedures in 20 patients via dRA were identified. Patients' mean age was 69.4 years (range 53-87 years). 3 patients were female. Mean radial artery diameter was 2.1 mm (range 1.6-2.8 mm). dRA access was achieved in all cases. Conversion to femoral access was required in 2 cases (9.1%) due to persistent radial artery vasospasm resulting in patient discomfort despite multiple additional doses of intraarterial vasodilators and added intravenous sedation as well as tortuous vessel anatomy and limited support of the catheters in a type 3 aortic arch for left CAS.

CONCLUSION: Our preliminary experience with dRA access for CAS suggests this approach to be feasible and safe for patients. Technical considerations are important and preprocedural planning is necessary for a successful intervention. Catheter systems and devices specifically designed for radial access are needed to enable more interventionalists to safely perform neurointerventional procedures via wrist access.


Distal radial artery, carotid artery stenting, snuffbox, stenosis, transradial access

DOI of Published Version



Kühn AL, Singh J, Moholkar VM, Satti SR, Rodrigues KM, Massari F, Gounis MJ, McGowen A, Puri AS. Distal radial artery (snuffbox) access for carotid artery stenting - Technical pearls and procedural set-up. Interv Neuroradiol. 2020 Sep 13:1591019920959537. doi: 10.1177/1591019920959537. Epub ahead of print. PMID: 32924692. Link to article on publisher's site

Journal/Book/Conference Title

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences

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Link to Article in PubMed

PubMed ID