Safety and feasibility of ulnar artery access for neuroangiography and neurointervention: a case series

Abstract

BackgroundRadial access has become popular among neurointerventionalists because it has favorable risk profiles compared with femoral access. Difficulties in accessing or navigating the radial artery have been viewed as a reason to convert to femoral access, but ulnar artery access may prevent complications associated with transfemoral procedures.ObjectiveTo evaluate the safety and feasibility of ulnar access for neurointerventions and diagnostic neuroangiographic procedures.MethodsConsecutive patients who underwent diagnostic angiography or neurointerventional procedures via ulnar access between July 1, 2019 and April 15, 2020 were included. Data recorded were demographics, procedure indication, devices, technique, and complications. Descriptive analysis was performed.ResultsUlnar artery access was obtained for 21 procedures in 18 patients (mean age 70.3±7.8 years; nine men). Procedures included 13 diagnostic angiograms and eight neurointerventions (3 left middle meningeal artery embolization, 1 of which was aborted; 2 carotid artery stenting; 2 angioplasty; 1 mechanical thrombectomy for in-stent thrombosis). A right-sided approach with ultrasound guidance was used for all cases except one. Indications included small caliber radial artery (n=9), radial artery occlusion (n=10), and radial artery preservation for potential bypass (n=2). A 5-French slender sheath was used for diagnostic angiography; a 6-French slender sheath was used for neurointerventions. No case required conversion to femoral access. Two patients had minor hematomas after the procedure; one other had ulnar artery occlusion on 30-day ultrasonography.ConclusionUlnar access is safe and feasible for diagnostic and interventional neuroangiographic procedures. It provides a useful alternative to radial access, potentially avoiding complications associated with femoral access.

Novel usage of everolimus-eluting coronary stent for intracranial atherosclerotic disease: a technical report and case series

“…For neurointerventional procedures, the trans-radial approach resulted in lower odds of complication than the trans-femoral approach 19. While there have not been many studies comparing trans-ulnar with trans-radial approach, a trans-ulnar approach is described as an alternative to trans-radial access 20. In randomized studies for coronary interventions, complication risks using trans-ulnar access were found to be close to trans-radial access 21 22.…”

“… 19 While there have not been many studies comparing trans-ulnar with trans-radial approach, a trans-ulnar approach is described as an alternative to trans-radial access. 20 In randomized studies for coronary interventions, complication risks using trans-ulnar access were found to be close to trans-radial access. 21 22 Therefore, success in deploying the Xience Skypoint using three different approaches demonstrate the stent’s flexibility, which gives providers the ability to perform their cases in a way that will be most beneficial to their patients.…”

Common ground, different path: Ulnar artery access for interventional neurovascular procedures

“…Dossani et.al has published the only available dedicated case series utilizing TUA for neurovascular procedures. 17 It comprised eighteen patients with only limited interventional procedures. Recently Ahmad et.al published their institutional experience of 760 neuro-interventions performed via upper extremity access.…”

“…There is only one available case series comprising 18 patients regarding the use of TUA for cerebral angiography and neuro-interventional procedures. 17 Joshi et al recently published a review of literature including 1342 patients undergoing trans-radial approach for neuro-interventions. 64 out of 1342 patients (4.77%) had failed trans-radial approach and a crossover to trans-femoral access was made for the completion of procedure.…”