Introduction: Most neuroendovascular interventions rely on a transfemoral approach to the intracranial circulation, however this is sometimes not possible due to complex aortic arch anatomy or femoral arterial disease. Transradial arteriography and intervention is well established in interventional cardiology and there have been some reports of successful neurointervention using this technique. The incidence of radial artery occlusion or other access site complication after transradial access is directly related to the outer diameter of the sheath used to access the artery.
Methods: We describe a technique to directly access the radial artery with a 070 Neuron catheter, without the need for a large 6-F sheath, for cerebrovascular interventions.
Results: Two successful cases are described in which this technique was used. Case one describes the successful Y-stent placement for coiling of a basilar tip aneurysm, and case two describes coiling of a ruptured PICA aneurysm.
Conclusions: The 070 Neuron catheter can be used in a direct access transradial approach to the cerebrovascular circulation for complex interventions without a radial sheath, thereby maximizing guide catheter diameter and minimizing the radial arteriotomy size.
Patient Care: Using this novel technique, radial arteriotomy size can be minimized, thereby potentially reducing the risk of access site complication, while allowing for excellent vertebral artery access for cerebral intervention.
Learning Objectives: 1) Review risks associated with transradial vascular access.
2) Review new technique to obtain large distal access via an 070 Neuron catheter while minimizing the diameter of the radial arteriotomy.
References: 1. Agostoni P, Biondi-Zoccai GGL, De Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures: Systematic overview and meta-analysis of randomized trials. Journal of the American College of Cardiology 2004;44(2):349-56.
2. Eichhofer J, Horlick E, Ivanov J, Seidelin PH, Ross JR, Ing D, et al. Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: A large single-center experience. American Heart Journal 2008;156(5):864-70.
3. Jolly SS, Yusuf S, Cairns J, Niemelv§ K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. The Lancet 2011;377(9775):1409-20.
4. Jo KW, Park SM, Kim SD, Kim SR, Baik MW, Kim YW. Is Transradial Cerebral Angiography Feasible and Safe? A Single Center's Experience. J Korean Neurosurg Soc 2010;47(5):332-7.
5. Levy EI, Boulos AS, Fessler RD, Bendok BR, Ringer AJ, Kim SH, et al. Transradial cerebral angiography: an alternative route. Neurosurgery 2002;51(2):335-40; discussion 40-2.
6. Levy EI, Kim SH, Bendok BR, Qureshi AI, Guterman LR, Hopkins LN. Transradial stenting of the cervical internal carotid artery: technical case report. Neurosurgery 2003;53(2):448-51; discussion 51-2.
7. Bendok BR, Przybylo JH, Parkinson R, Hu Y, Awad IA, Batjer HH. Neuroendovascular interventions for intracranial posterior circulation disease via the transradial approach: technical case report. Neurosurgery 2005;56(3):E626; discussion E26.
8. Eskioglu E, Burry MV, Mericle RA. Transradial approach for neuroendovascular surgery of intracranial vascular lesions. Journal of Neurosurgery 2004;101(5):767-69.
9. Pancholy S, Coppola J, Patel T, Roke-Thomas M. Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization. Catheter Cardiovasc Interv 2008;72(3):335-40.
10. Stella PR, Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R. Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty. Cathet Cardiovasc Diagn 1997;40(2):156-8.
11. Uhlemann M, Mv?bius-Winkler S, Mende M, Eitel I, Fuernau G, Sandri M, et al. The Leipzig Prospective Vascular Ultrasound Registry in Radial Artery Catheterization: Impact of Sheath Size on Vascular Complications. JACC: Cardiovascular Interventions 2012;5(1):36-43.