Rimal H Dossani1,2, Muhammad Waqas1,2, Michael K Tso1,2, Justin M Cappuzzo1,2, Daniel Popoola3, Kenneth V Snyder1,2,4,5, Elad I Levy1,2,4,5,6, Adnan H Siddiqui1,2,4,5,6, Jason M Davies1,2,4,5,7. 1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. 2. Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA. 3. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. 4. Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA. 5. Jacobs Institute, Buffalo, NY, USA. 6. Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. 7. Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Abstract
BACKGROUND: Radial loops are rare congenital radial artery anomalies that may pose a significant challenge to successful transradial neuroangiography. In this case series, we describe the anatomy and frequency of radial artery loops and provide a technique for successful navigation of this anatomic anomaly. METHODS: We reviewed our database of radial diagnostic or interventional neuroangiographic procedures to identify cases in which a radial loop was encountered during the procedure. The loop pattern, the presence of an associated recurrent radial artery branch, navigation technique, and procedure-related complications were recorded. A descriptive analysis was performed. RESULTS: A total of 997 transradial approach procedures were performed over a 9-month period. A radial loop was identified in 10 (1.0%) patients. The average age was 68.6 ± 14.3 years. A microcatheter advanced over a microwire was used to navigate the loop and avoid entry into the recurrent branch. A diagnostic neuroangiographic procedure was performed successfully in 8 cases and an intervention was performed successfully in 1 case. A 360° loop was present in 2 of these cases. In each case, transradial access was performed successfully. In 1 other diagnostic case, transradial access was aborted, and the femoral artery was accessed to perform the procedure. CONCLUSIONS: A radial loop was present in 1% of the cases in this series. Our technical results suggest that this anomaly should not be considered a contraindication to transradial neuroangiography because the procedure was successfully performed in most (9 of 10) cases using a microcatheter system to navigate the loop.
BACKGROUND: Radial loops are rare congenital radial artery anomalies that may pose a significant challenge to successful transradial neuroangiography. In this case series, we describe the anatomy and frequency of radial artery loops and provide a technique for successful navigation of this anatomic anomaly. METHODS: We reviewed our database of radial diagnostic or interventional neuroangiographic procedures to identify cases in which a radial loop was encountered during the procedure. The loop pattern, the presence of an associated recurrent radial artery branch, navigation technique, and procedure-related complications were recorded. A descriptive analysis was performed. RESULTS: A total of 997 transradial approach procedures were performed over a 9-month period. A radial loop was identified in 10 (1.0%) patients. The average age was 68.6 ± 14.3 years. A microcatheter advanced over a microwire was used to navigate the loop and avoid entry into the recurrent branch. A diagnostic neuroangiographic procedure was performed successfully in 8 cases and an intervention was performed successfully in 1 case. A 360° loop was present in 2 of these cases. In each case, transradial access was performed successfully. In 1 other diagnostic case, transradial access was aborted, and the femoral artery was accessed to perform the procedure. CONCLUSIONS: A radial loop was present in 1% of the cases in this series. Our technical results suggest that this anomaly should not be considered a contraindication to transradial neuroangiography because the procedure was successfully performed in most (9 of 10) cases using a microcatheter system to navigate the loop.
Authors: Brian M Snelling; Samir Sur; Sumedh S Shah; Justin Caplan; Priyank Khandelwal; Dileep R Yavagal; Robert M Starke; Eric C Peterson Journal: Oper Neurosurg (Hagerstown) Date: 2019-09-01 Impact factor: 2.703
Authors: Sudhir Rathore; Rodney H Stables; Maheshwar Pauriah; Abdul Hakeem; Joseph D Mills; Nick D Palmer; Raphael A Perry; John L Morris Journal: JACC Cardiovasc Interv Date: 2010-05 Impact factor: 11.195
Authors: N Yokoyama; S Takeshita; M Ochiai; Y Koyama; S Hoshino; T Isshiki; T Sato Journal: Catheter Cardiovasc Interv Date: 2000-04 Impact factor: 2.692
Authors: T S Lo; J Nolan; E Fountzopoulos; M Behan; R Butler; S L Hetherington; K Vijayalakshmi; R Rajagopal; D Fraser; A Zaman; D Hildick-Smith Journal: Heart Date: 2008-10-31 Impact factor: 5.994
Authors: Eyad Almallouhi; Sami Al Kasab; Mithun G Sattur; Jonathan Lena; Pascal M Jabbour; Ahmad Sweid; Nohra Chalouhi; M Reid Gooch; Robert M Starke; Eric C Peterson; Dileep R Yavagal; Stephanie H Chen; Yangchun Li; Bradley A Gross; Daniel A Tonetti; Benjamin M Zussman; Jeremy G Stone; Ashutosh P Jadhav; Brian T Jankowitz; Christopher C Young; Do H Lim; Michael R Levitt; Joshua W Osbun; Alejandro M Spiotta Journal: J Neurointerv Surg Date: 2020-03-26 Impact factor: 5.836