On the basis of the results, the authors conclude that the Neuroform self-expanding stent is a flexible and useful device that can be readily and safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. Early in the authors' experience, stent delivery presented difficulties; however, a second generation of devices has resolved this limitation. Although the early results are promising, the long-term benefit of this technique has to be proved by angiographic and clinical follow-up examinations.
Background:Several benefits have been described over the years of the transradial versus femoral endovascular approach to cardiac interventions. Consequently, its use has become habitual at most centers that perform cardiac catheterizations. This paper details a right transradial approach, incorporating a variety of coils or flow diverters, which can be utilized for the endovascular treatment of different cerebral aneurysms.Methods:From 2014 to 2016, we performed 40 endovascular procedures to treat cerebral aneurysms adopting the same right transradial approach. Five aneurysms were treated with flow diverters and 35 were treated with coils. Seven of these aneurisms were asymptomatic, whereas 33 had already ruptured.Results:Satisfactory treatment was achieved in all cases through the same approach in the absence of any complications.Conclusions:A right transradial approach may be satisfactory for the endovascular treatment of different cerebral aneurysms, including aneurysms in either hemisphere. This is the largest series of cerebral aneurysms treated through a transradial approach.
Background: The transradial approach results in fewer complications at the puncture site, lower hospital costs, and greater comfort for patients. The distal transradial approach (dTRA) adds some benefits over the conventional radial approach. The objective is to describe initial experience with distal radial approach technique and the results obtained for neuroendovascular diagnostic and therapeutic procedures. Methods: Description of distal radial approach technique and obtained data from the first 3 months experience using this approach as the first choice for neuroendovascular procedures in two neuroendovascular centers. Results: Of the total of 94 procedures performed during 3 months, 67 were diagnostic and 27 were therapeutic. Eleven (16%) of the diagnostic procedures were performed through the dTRA. Of the 27 embolizations, eight (30%) were done using this approach. Every distal radial approach that was performed for diagnosis and therapeutics was successful. Conclusion: Puncture of the radial artery within the anatomical snuffbox is a radial approach variation option for diagnostic and therapeutic neuroendovascular procedures.
Background: For cardiovascular procedures, the transradial approach has been documented to yield fewer complications than the femoral approach. It has become the approach of choice for diagnostic and therapeutic interventions involving the coronary arteries. However, few published data exist on using this approach for neuroendovascular procedures and we describe a series of ruptured cerebral aneurysms diagnosed and treated using the transradial approach. Methods: All patients scheduled for cerebral angiography to diagnose and treat subarachnoid hemorrhages at our hospital from June 2016 to May 2018, by right radial artery access, were recruited and followed prospectively. The main outcomes of interest were the length of the procedure (in minutes), the success of treatment, and the incidence of postprocedural complications. Results: Over the observation period, 59 patients (66% women, mean age = 48 years) with a combined 61 aneurysms treated were identified who met inclusion criteria. Of the 61 aneurysms treated, eight (13%) were within the posterior circulation (13%) and 53 (87%) the anterior circulation. Average procedural duration was 64.9 min. No occlusion or spasm of the radial artery was observed during any procedure. All patients had immediate pre- and post-embolization angiography, which revealed the guide catheter coming from the right subclavian artery. A radial pulse was evident after all interventions. All procedures were considered successful at treating the ruptured aneurysm, and no patient experienced a clinically significant complication related to the approach. Conclusions: The transradial approach is a viable option for the diagnosis and endovascular treatment of acute cerebral aneurysms in different locations.
Background: The transfemoral approach (TFA) has been the standard in neuroradiology over the years. However, the transradial approach (TRA) and its variants offer several benefits over the TFA. Methods: Review of the literature about TRA and its variations. We present our results for different neurointerventional procedures at our institution between January 2018 and December 2019. Results: We wrote an educational review describing anatomical and technical aspects, advantages, and complications of this approach. In the past year we increased the percentage of neurointerventional procedures performed through radial or ulnar arteries. Conclusion: There are clearly proven benefits of employing a wrist approach in patients for neurointerventional procedures and its utilization should especially be considered on a daily basis.
Background: Major advances in the endovascular treatment of cerebral aneurysms have reduced the incidence of intra- and postprocedural complications. The length of stay after treatment for incidental aneurysms remains between early next-day discharge and 2 days. We hypothesized that discharging patients the same day would not be associated with any increase in the rate of postdischarge adverse events. Methods: We retrospectively reviewed the charts of patients who underwent an elective coiling procedure between 2015 and 2020 at three centers and were discharged from hospital on the same day as the procedure. Patients were clinically evaluated 6 h, 1 week, and 6 months after the procedure, with repeat cerebral angiography performed 1 year after the procedure. Results: Eleven eligible patients underwent outpatient treatment of 12 aneurysms treated through the wrist. No complications were identified within 1 week of the procedure. Clinical evaluation 6 months after treatment also failed to reveal any complication associated with the procedure. Only one of the seven patients who underwent 1 year angiography required retreatment. Conclusion: It is possible to safely perform coiled embolization of cerebral aneurysms in select outpatients with unruptured cerebral aneurysms.
OBJETIVO:Describir una serie de casos en los que se realizó tratamiento de aneurismas cerebrales con diversores de flujo a través de la muñeca con técnica coaxial. MATERIALES Y MÉTODOS: Se analizaron las bases de datos de dos instituciones de todos los aneurismas cerebrales tratados condiversores de flujo entre enero de 2019 y julio de 2021. Se describen las características y la localización de los aneurismas tratados a través de la muñeca, y se describe la técnica utilizada. RESULTADOS: En el período estudiado se implantaron 29 diversores de flujo en 28 pacientes, de los cuales 22 fueron a través de la muñeca; 7 fueron a través de abordaje femoral, y hubo un caso decruce de abordaje (crossover). De los 22 casos tratados por la muñeca, 16 fueron mujeres y la edad promedio fue de 53 años (rango 33-70 años). Un paciente fue tratado dos veces, debido a falla en el primer tratamiento (aneurisma gigante permeable un año después de haber sido tratado con diversor de flujo y coils). Se realizaron 11 procedimientos a través de abordaje radial derecho, 2 por abordaje radial distal derecho, 4 por abordaje radial izquierdo, 3 por abordaje cubital derecho, y 2 por abordaje radial bilateral. En 5 casos se trató de aneurismas múltiples; 6 fueron aneurismas grandes, 2 gigantes, y 3 disecantes. Un aneurisma había sido previamente tratado con coils en agudo, y dos pacientes habían sido previamente tratados con diversores de flujo. 14 de los aneurismas tratados estaban ubicados en el circuito anterior, de los cuales 10 estaban en el territorio de la arteria carótida interna izquierda, y 8 aneurismas ubicados en el circuito posterior. Se utilizó introductor arterial 6 Fr. En los aneurismas del circuito anterior se cateterizó la arteria portadora con un catéter diagnóstico Simmons II 5 fr, y se realizó intercambio por el catéter de acceso distal. En los aneurismas del circuito posterior se cateterizó la arteria portadora del aneurisma directamente con un catéter de acceso distal sobre una guía hidrofílica. En todos los casos se utilizó la técnica coaxial en forma directa con el catéter de acceso distal, excepto en dos casos en los cuales ante la necesidad deimplantar diversores de flujo mayores a 5mm de diámetro en territorio carotídeo se utilizó la técnica triaxial (vaina y catéter de acceso distal). Los catéteres de acceso distal utilizados fueron: Navien 6 Fr (18 casos), Fargo Max 6Fr(2 casos) y Catalyst 5 (2 casos). Los dispositivos utilizados fueron: 14 Pipeline, 2 FRED, 2 DERIVO, y 4 SILK. En todos los casos se obtuvo el soporte suficiente para navegar y liberar el diversor de flujo en la posición planificada. No hubo complicaciones durante los procedimientos, ni en relación al sitio de punción. Los pacientes fueron dados de alta entre las 24 y 48 hs. Ningún paciente presentó déficit neurológico agregado y la mortalidad fue 0%. CONCLUSIONES: Se describe una serie de casos de aneurismas cerebrales tratados con diversores de flujo a través de la muñeca con técnica coaxial. Constituye la serie de casos más grande tratados con diversores de flujo con esta técnica.
OBJETIVO Comparar el tiempo de fluoroscopia y la dosis de radiación entre procedimientos neuro endovasculares realizados por acceso arterial radial y femoral en nuestro centro durante un período de 1 año. MATERIAL Y MÉTODOS Se revisó la base de datos de procedimientos diagnósticos y terapéuticos neuro endovasculares realizados en uno de los angiógrafos de la institución desde el 1 de enero al 31 de diciembre de 2019. Se dividieron los casos según el sitio de acceso (abordajes femorales y radiales). Se analizaron los registros de medición del equipo de: tiempo de fluoroscopia (sumatoria del tiempo utilizado en modo adquisición y el modo fluoroscopia), dosis de radiación cuantificada como kerma en aire (medida indirecta de la dosis cutánea máxima y predictora del riesgo de lesión cutánea) y producto dosis-área (valor utilizado para calcular el riesgo estocástico relativo). Finalmente se compararon las tres variables entre ambos grupos. RESULTADOS En este período se estudiaron y trataron por vía endovascular 137 pacientes, 76 por abordaje radial y 61 femoral. La mediana del tiempo de fluoroscopia fue mayor en los casos de acceso radial (12,95 min vs 7,78 min respectivamente, p= 0,012). La media de kerma en aire fue más alta con el acceso radial en comparación con el acceso femoral (0,842 Gy vs 0,575 Gy respectivamente, p= 0,052). Cuando se tienen en cuenta solamente los procedimientos terapéuticos, la diferencia de la media de kerma en aire de ambos abordajes no tuvo significancia estadística (1,56 Gy vs 1,43 Gy respectivamente, p=0,417). La mediana del producto dosis-área no fue estadísticamente diferente entre ambos accesos (0,093 Gy.m2 vs 0,075 Gy.m2 respectivamente, p= 0,069). CONCLUSIONES El tiempo de fluoroscopia y la media de kerma en aire fue significativamente mayor en los casos de acceso radial que en los de acceso femoral para todos los procedimientos. No se observaron diferencias significativas en la radiación medida como kerma en aire para procedimientos terapéuticos entre ambos grupos. La dosis de radiación medida como producto dosis-área no mostró diferencias significativas entre ambos tipos de abordajes.
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