Original ArticleTransradial Approach as the Primary Vascular Access with a 6-Fr Simmons Guiding Sheath for Anterior Circulation Interventions: A Single-Center Case Series of 130 Consecutive Patients
Introduction
The transfemoral approach (TFA) is traditionally used as the primary vascular access to the common carotid artery (CCA) during neurointerventions. This approach, however, can be challenging or contraindicated in patients with unfavorable anatomy in the target CCA or the aortic arch, and/or peripheral vascular disease. In addition, TFA increases the risk of developing access site–related vascular complications.1,2 The transbrachial approach can result in high rate of severe complications, including massive brachial hematoma, compartment syndrome, pseudoaneurysm, injury to the median nerve, or hand ischemia.3,4
The advantages of the transradial approach (TRA) for coronary interventions are well documented. These include fewer vascular complications, better patient comfort, and immediate ambulation.4, 5, 6, 7, 8 During neurointerventions, previous studies have demonstrated that conventional TRA with a straight-shaped guiding system can be used as an alternative vascular access for accessing anterior circulation lesions, especially in right CCA lesions and left CCA lesions with a bovine origin.9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 However, TRA can be technically difficult for a certain population of patients with unfavorable acute takeoff of the target CCA, such as those with right CCA lesions with steep angulation to the right subclavian artery or left CCA lesions with a nonbovine origin.10,11,13, 14, 15, 16,21 We previously reported that TRA with a 6-Fr “Simmons-shaped” guiding sheath was useful even in such challenging conditions because a pre-shaped Simmons curve provides kink resistance and high stability.22, 23, 24, 25 The purpose of the present study was to evaluate the feasibility and safety of neurointerventional TRA as the primary vascular access with a 6-Fr Simmons guiding sheath specifically designed for transradial carotid cannulation.
Section snippets
Patient Selection
From June 2018, we selected right TRA as the first-line, left TRA as the second-line, and TFA as the third-line vascular access during neurointerventions for anterior circulation lesions including carotid artery stenting (CAS) and cerebral aneurysm coiling at our institute. The selection criteria to prioritize TRA have been described previously 25: (1) favorable access routes were confirmed based on preprocedural images, (2) the pulsation of the radial artery was detected, and (3) the Allen
Results
The characteristics of the 130 patients are shown in Table 1. The target CCA was the right CCA for 69 (53.0%) patients, the bovine left CCA for 6 (4.6%) patients, and the nonbovine left CCA for 55 (42.3%) patients. Transradial access success was achieved for all 130 patients (Figure 5). Of these, 2 patients were successfully cannulated with crossover to another technique through TRA (Table 2 and Figure 5). TRA was not abandoned or switched to TFA for any patient. The neurointervention
Discussion
Our results indicate that TRA as the primary vascular access with a 6-Fr Simmons guiding sheath for anterior circulation interventions is highly successful and safe. Transradial carotid cannulation and the subsequent procedure were successfully performed without periprocedural or vascular access site complications for all 130 patients treated.
Conclusions
Based on our experience, TRA with a 6-Fr Simmons guiding sheath for anterior circulation interventions is a highly successful and safe method for all target CCAs and aortic arch types. This method can be utilized as the primary vascular access for anterior circulation interventions. A preprocedural anatomical assessment is required for favorable outcomes.
CRediT authorship contribution statement
Yoshiki Hanaoka: Conceptualization, Methodology, Data curation, Writing - original draft, Investigation. Jun-ichi Koyama: Conceptualization, Writing - review & editing, Validation. Daisuke Yamazaki: Investigation. Yoshinari Miyaoka: Investigation. Yu Fujii: Investigation. Takuya Nakamura: Investigation. Toshihiro Ogiwara: Supervision. Kiyoshi Ito: Supervision. Tetsuyoshi Horiuchi: Writing - review & editing, Supervision.
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2023, World NeurosurgeryCitation Excerpt :The 6F Simmons guiding sheath was removed immediately after the procedure and hemostasis was achieved using a hemostatic device. Details on hemostasis have been described in previous studies.14-16,18 Computed tomography scan and diffusion-weighted magnetic resonance imaging were performed within 24 h after the endovascular procedure.
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.