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Research ArticleInterventional

Anatomic Snuffbox (Distal Radial Artery) and Radial Artery Access for Treatment of Intracranial Aneurysms with FDA-Approved Flow Diverters

A.L. Kühn, S.R. Satti, T. Eden, K. de Macedo Rodrigues, J. Singh, F. Massari, M.J. Gounis and A.S Puri
American Journal of Neuroradiology March 2021, 42 (3) 487-492; DOI: https://doi.org/10.3174/ajnr.A6953
A.L. Kühn
aFrom 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
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S.R. Satti
bDepartment of Neurointerventional Surgery (S.R.S., T.E.), Christiana Health System, Newark, Delaware
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T. Eden
bDepartment of Neurointerventional Surgery (S.R.S., T.E.), Christiana Health System, Newark, Delaware
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K. de Macedo Rodrigues
aFrom 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
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J. Singh
aFrom 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
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F. Massari
aFrom 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
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M.J. Gounis
aFrom 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
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A.S Puri
aFrom 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
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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.

ABBREVIATIONS:

CCA
common carotid artery
dRA
distal radial artery
FD
flow diverter
RA
radial artery
TRA
transradial access
  • © 2021 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 42 (3)
American Journal of Neuroradiology
Vol. 42, Issue 3
1 Mar 2021
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Anatomic Snuffbox (Distal Radial Artery) and Radial Artery Access for Treatment of Intracranial Aneurysms with FDA-Approved Flow Diverters
A.L. Kühn, S.R. Satti, T. Eden, K. de Macedo Rodrigues, J. Singh, F. Massari, M.J. Gounis, A.S Puri
American Journal of Neuroradiology Mar 2021, 42 (3) 487-492; DOI: 10.3174/ajnr.A6953

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Anatomic Snuffbox (Distal Radial Artery) and Radial Artery Access for Treatment of Intracranial Aneurysms with FDA-Approved Flow Diverters
A.L. Kühn, S.R. Satti, T. Eden, K. de Macedo Rodrigues, J. Singh, F. Massari, M.J. Gounis, A.S Puri
American Journal of Neuroradiology Mar 2021, 42 (3) 487-492; DOI: 10.3174/ajnr.A6953
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