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Research ArticleInterventional

CTA-Based Patient-Tailored Femoral or Radial Frontline Access Reduces the Rate of Catheterization Failure in Chronic Subdural Hematoma Embolization

E. Shotar, G. Pouliquen, K. Premat, A. Pouvelle, S. Mouyal, L. Meyblum, S. Lenck, V. Degos, S. Abi Jaoude, N. Sourour, B. Mathon and F. Clarençon
American Journal of Neuroradiology March 2021, 42 (3) 495-500; DOI: https://doi.org/10.3174/ajnr.A6951
E. Shotar
aFrom the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
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G. Pouliquen
aFrom the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
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K. Premat
aFrom the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
dSorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
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  • ORCID record for K. Premat
A. Pouvelle
aFrom the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
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S. Mouyal
aFrom the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
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L. Meyblum
aFrom the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
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S. Lenck
aFrom the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
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V. Degos
bNeurosurgical Anesthesiology and Critical Care (V.D.)
dSorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
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S. Abi Jaoude
cNeurosurgery (S.A.J., B.M.), Pitié-Salpêtrière Hospital, Paris, France
dSorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
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N. Sourour
aFrom the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
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B. Mathon
cNeurosurgery (S.A.J., B.M.), Pitié-Salpêtrière Hospital, Paris, France
dSorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
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F. Clarençon
aFrom the Department of Neuroradiology (E.S., G.P., K.P., A.P., S.M., L.M., S.L., N.S., F.C.)
dSorbonne Université (K.P., V.D., S.A.J., B.M., F.C.), Paris, France
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Abstract

BACKGROUND AND PURPOSE: Chronic subdural hematoma embolization, an apparently simple procedure, can prove to be challenging because of the advanced age of the target population. The aim of this study was to compare 2 arterial-access strategies, femoral versus patient-tailored CTA-based frontline access selection, in chronic subdural hematoma embolization procedures.

MATERIALS AND METHODS: This was a monocentric retrospective study. From the March 15, 2018, to the February 14, 2019 (period 1), frontline femoral access was used. Between February 15, 2019, and March 30, 2020 (period 2), the choice of the frontline access, femoral or radial, was based on the CTA recommended as part of the preoperative work-up during both above-mentioned periods. The primary end point was the rate of catheterization failure. The secondary end points were the rate of access site conversion and fluoroscopy duration.

RESULTS: During the study period, 124 patients (with 143 chronic subdural hematomas) underwent an embolization procedure (mean age, 74 [SD, 13] years). Forty-eight chronic subdural hematomas (43 patients) were included during period 1 and were compared with 95 chronic subdural hematomas (81 patients) during period 2. During the first period, 5/48 (10%) chronic subdural hematoma embolizations were aborted due to failed catheterization, significantly more than during period 2 (1/95, 1%; P = .009). The rates of femoral-to-radial (P = .55) and total conversion (P = .86) did not differ between the 2 periods. No significant difference was found regarding the duration of fluoroscopy (P = .62).

CONCLUSIONS: A CTA-based patient-tailored choice of frontline arterial access reduces the rate of catheterization failure in chronic subdural hematoma embolization procedures.

ABBREVIATIONS:

CSDH
chronic subdural hematoma
MMA
middle meningeal artery
  • © 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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CTA-Based Patient-Tailored Femoral or Radial Frontline Access Reduces the Rate of Catheterization Failure in Chronic Subdural Hematoma Embolization
E. Shotar, G. Pouliquen, K. Premat, A. Pouvelle, S. Mouyal, L. Meyblum, S. Lenck, V. Degos, S. Abi Jaoude, N. Sourour, B. Mathon, F. Clarençon
American Journal of Neuroradiology Mar 2021, 42 (3) 495-500; DOI: 10.3174/ajnr.A6951

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CTA-Based Patient-Tailored Femoral or Radial Frontline Access Reduces the Rate of Catheterization Failure in Chronic Subdural Hematoma Embolization
E. Shotar, G. Pouliquen, K. Premat, A. Pouvelle, S. Mouyal, L. Meyblum, S. Lenck, V. Degos, S. Abi Jaoude, N. Sourour, B. Mathon, F. Clarençon
American Journal of Neuroradiology Mar 2021, 42 (3) 495-500; DOI: 10.3174/ajnr.A6951
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