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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
Footnotes
Disclosures: Sudhakar R. Satti—RELATED: Consulting Fee or Honorarium: Medtronic; Other: Medtronic, Pipeline proctor.* Matthew J. Gounis—UNRELATED: Consultancy: Astrocyte Pharmaceuticals, Cerenovous, Imperative Care, Medtronic, MIVI Neurosciences, phenox, Q’Apel, Route 92 Medical, Stryker Neurovascular, Consultancy: Wallaby Medical, Comments: fee-per-hour consulting; Grants/Grants Pending: National Institutes of Health, Israel Binational Science Foundation, Anaconda, ApicBio, Arsenal Medical, Axovant, Cerenovus, Ceretrieve, Cook Medical, Galaxy Therapeutics, Gentuity, Imperative Care, InNeuroCo, Insera, Magneto, MicroVention, Medtronic, MIVI Neurosciences, Naglreiter MDDO, Neurogami, Omniox, Philips Healthcare, Progressive Medical, Pulse Medical, Rapid Medical, Route 92 Medical, Stryker Neurovascular, Syntheon, ThrombX Medical, the Wyss Institute, Xtract Medical*; Stock/Stock Options: Galaxy Therapeutics, Imperative Care, InNeuroCo, Neurogami. Ajit Puri—RELATED: Consulting Fee or Honorarium: proctor for Stryker, Cerenovus, Medtronic, and MicroVention; UNRELATED: Consultancy: consultant for Q’Apel, Merit Medical, Arsenal medical; Grants/Grants Pending: small business innovation research, National Institutes of Health*; Payment for Lectures Including Service on Speakers Bureaus: Merit Medical, Cerenovus, Q’Apel; Stock/Stock Options: InNeuroCo, Galaxy therapeutics, Neurotherapeutics Inc., Agile Medical, Perfuze. *Money paid to the institution.
- © 2021 by American Journal of Neuroradiology