A L Kühn1, S R Satti2, T Eden2, K de Macedo Rodrigues1, J Singh1, F Massari1, M J Gounis1, A S Puri3. 1. From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts. 2. Department of Neurointerventional Surgery (S.R.S., T.E.), Christiana Health System, Newark, Delaware. 3. From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts ajit.puri@umassmemorial.org.
Abstract
BACKGROUND AND PURPOSE: Transradial access for neurointerventional procedures has been proved a safer and more comfortable alternative to femoral artery access. We present our experience with transradial (distal radial/anatomic snuffbox and radial artery) access for treatment of intracranial aneurysms using all 3 FDA-approved flow diverters. MATERIALS AND METHODS: This was a high-volume, dual-center, retrospective analysis of each institution's data base between June 2018 and June 2020 and a collection of all patients treated with flow diversion via transradial access. Patient demographic information and procedural and radiographic data were obtained. RESULTS: Seventy-four patients were identified (64 female patients) with a mean age of 57.5 years with a total of 86 aneurysms. Most aneurysms were located in the anterior circulation (93%) and within the intracranial ICA (67.4%). The mean aneurysm size was 5.5 mm. Flow diverters placed included the Pipeline Embolization Device (Flex) (PED, n = 65), the Surpass Streamline Flow Diverter (n = 8), and the Flow-Redirection Endoluminal Device (FRED, n = 1). Transradial access was successful in all cases, but femoral crossover was required in 3 cases (4.1%) due to tortuous anatomy and inadequate support of the catheters in 2 cases and an inability to navigate to the target vessel in a patient with an aberrant right subclavian artery. All 71 other interventions were successfully performed via the transradial approach (95.9%). No access site complications were encountered. Asymptomatic radial artery occlusion was encountered in 1 case (3.7%). CONCLUSIONS: Flow diverters can be successfully placed via the transradial approach with high technical success, low access site complications, and a low femoral crossover rate.
BACKGROUND AND PURPOSE: Transradial access for neurointerventional procedures has been proved a safer and more comfortable alternative to femoral artery access. We present our experience with transradial (distal radial/anatomic snuffbox and radial artery) access for treatment of intracranial aneurysms using all 3 FDA-approved flow diverters. MATERIALS AND METHODS: This was a high-volume, dual-center, retrospective analysis of each institution's data base between June 2018 and June 2020 and a collection of all patients treated with flow diversion via transradial access. Patient demographic information and procedural and radiographic data were obtained. RESULTS: Seventy-four patients were identified (64 female patients) with a mean age of 57.5 years with a total of 86 aneurysms. Most aneurysms were located in the anterior circulation (93%) and within the intracranial ICA (67.4%). The mean aneurysm size was 5.5 mm. Flow diverters placed included the Pipeline Embolization Device (Flex) (PED, n = 65), the Surpass Streamline Flow Diverter (n = 8), and the Flow-Redirection Endoluminal Device (FRED, n = 1). Transradial access was successful in all cases, but femoral crossover was required in 3 cases (4.1%) due to tortuous anatomy and inadequate support of the catheters in 2 cases and an inability to navigate to the target vessel in a patient with an aberrant right subclavian artery. All 71 other interventions were successfully performed via the transradial approach (95.9%). No access site complications were encountered. Asymptomatic radial artery occlusion was encountered in 1 case (3.7%). CONCLUSIONS: Flow diverters can be successfully placed via the transradial approach with high technical success, low access site complications, and a low femoral crossover rate.
Authors: Pierfrancesco Agostoni; Giuseppe G L Biondi-Zoccai; M Luisa de Benedictis; Stefano Rigattieri; Marco Turri; Maurizio Anselmi; Corrado Vassanelli; Piero Zardini; Yves Louvard; Martial Hamon Journal: J Am Coll Cardiol Date: 2004-07-21 Impact factor: 24.094
Authors: Brian M Snelling; Samir Sur; Sumedh S Shah; Priyank Khandelwal; Justin Caplan; Rianna Haniff; Robert M Starke; Dileep R Yavagal; Eric C Peterson Journal: J Neurointerv Surg Date: 2018-01-08 Impact factor: 5.836
Authors: Samir Sur; Brian Snelling; Priyank Khandelwal; Justin M Caplan; Eric C Peterson; Robert M Starke; Dileep R Yavagal Journal: Neurosurg Focus Date: 2017-04 Impact factor: 4.047
Authors: Sami M Alnasser; Akshay Bagai; Sanjit S Jolly; Warren J Cantor; Payam Dehghani; Sunil V Rao; Asim N Cheema Journal: Int J Cardiol Date: 2016-11-10 Impact factor: 4.164
Authors: Eyad Almallouhi; Jonathan Leary; Jeffrey Wessell; Sami Al Kasab; Suhas Pai; Mithun G Sattur; Jonathan R Lena; Alejandro M Spiotta Journal: J Neurointerv Surg Date: 2019-07-12 Impact factor: 5.836