Yoshiki Hanaoka1, Jun-Ichi Koyama2, Toshihiro Ogiwara3, Yu Fujii3, Kiyoshi Ito3, Tetsuyoshi Horiuchi3. 1. Department of Neurosurgery, Shinshu University School of Medicine, Matsumot, Japan. Electronic address: hanaoka@shinshu-u.ac.jp. 2. Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Nagano, Japan. 3. Department of Neurosurgery, Shinshu University School of Medicine, Matsumot, Japan.
Abstract
BACKGROUND: In cardiac intervention, the transradial approach (TRA) is increasingly used as the first-line approach owing to numerous advantages over the transfemoral approach. Neurointerventional TRA, especially in intracranial interventions, is predominantly restricted to an alternative approach, as transradial carotid cannulation using a conventional transfemoral system can be technically challenging for patients with unfavorable acute takeoff of the target common carotid artery. This study evaluated the feasibility and safety of first-line TRA with a radial-specific neurointerventional guiding sheath for a large series of consecutive intracranial anterior circulation aneurysm embolizations. METHODS: We retrospectively analyzed our institutional database of first-line TRA for consecutive coil embolizations of anterior circulation aneurysms conducted between June 2018 and March 2020. A radial-specific 6-F Simmons guiding sheath (0.088-inch inner diameter) was engaged into the target common carotid artery, and subsequently a triaxial or quadraxial system was created for the embolization procedure. We assessed procedural success and procedure-related or vascular access site complications. RESULTS: A total of 119 patients with intracranial anterior circulation aneurysms underwent 121 coil embolization procedures. Of these, 101 patients who underwent 103 (85.1%) embolization procedures treated with first-line TRA were included. After the triaxial or quadraxial system was constructed, the embolization procedure was successful for all 103 cases without catheter kinking, system instability, or complications. CONCLUSIONS: A transradial 0.088-inch triaxial or quadraxial system provided sufficient stability and kink resistance for intracranial aneurysm embolization. This method is feasible, highly successful, and safe for intracranial anterior circulation aneurysm embolization.
BACKGROUND: In cardiac intervention, the transradial approach (TRA) is increasingly used as the first-line approach owing to numerous advantages over the transfemoral approach. Neurointerventional TRA, especially in intracranial interventions, is predominantly restricted to an alternative approach, as transradial carotid cannulation using a conventional transfemoral system can be technically challenging for patients with unfavorable acute takeoff of the target common carotid artery. This study evaluated the feasibility and safety of first-line TRA with a radial-specific neurointerventional guiding sheath for a large series of consecutive intracranial anterior circulation aneurysm embolizations. METHODS: We retrospectively analyzed our institutional database of first-line TRA for consecutive coil embolizations of anterior circulation aneurysms conducted between June 2018 and March 2020. A radial-specific 6-F Simmons guiding sheath (0.088-inch inner diameter) was engaged into the target common carotid artery, and subsequently a triaxial or quadraxial system was created for the embolization procedure. We assessed procedural success and procedure-related or vascular access site complications. RESULTS: A total of 119 patients with intracranial anterior circulation aneurysms underwent 121 coil embolization procedures. Of these, 101 patients who underwent 103 (85.1%) embolization procedures treated with first-line TRA were included. After the triaxial or quadraxial system was constructed, the embolization procedure was successful for all 103 cases without catheter kinking, system instability, or complications. CONCLUSIONS: A transradial 0.088-inch triaxial or quadraxial system provided sufficient stability and kink resistance for intracranial aneurysm embolization. This method is feasible, highly successful, and safe for intracranial anterior circulation aneurysm embolization.
Authors: Young Erben; James F Meschia; Donald V Heck; Fayaz A Shawl; Minerva Mayorga-Carlin; George Howard; Kenneth Rosenfield; John D Sorkin; Thomas G Brott; Brajesh K Lal Journal: Catheter Cardiovasc Interv Date: 2021-08-13 Impact factor: 2.585
Authors: Faith C Robertson; Joseph R Linzey; Naif M Alotaibi; Robert W Regenhardt; Pablo Harker; Justin Vranic; Adam A Dmytriw; Matthew J Koch; Christopher J Stapleton; Thabele M Leslie-Mazwi; Aman B Patel Journal: Neuroradiol J Date: 2021-04-30