Transradial access in acute ischemic stroke intervention

Haussen, Diogo C; Nogueira, Raul G; DeSousa, Keith; Pafford, Ryan; Janjua, Nazli; Ramdas, Kevin; Peterson, Eric C.; Elhammady, Mohamed Samy; Yavagal, Dileep R.

doi:10.1136/neurintsurg-2014-011519

Cited by 91 publications

(82 citation statements)

References 13 publications

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“…14 Direct cervical carotid artery puncture, transbrachial, and transradial approaches have been described in this setting, but previous reports have typically focused on these nontraditional approaches as rescue measures after failed transfemoral attempts. 5,6,13,16 Further, experience with the transradial approach is often confined to posterior circulation access, and this approach with use of modern stent retriever technology has yet to be reported.At our institution, we have increasingly employed a transradial technique to access both anterior and posterior circulation LVOs, often as our initial approach, to achieve revascularization. Here we report our recent experience with stent retriever mechanical thrombectomy in patients with anterior circulation LVOs performed via a transradial approach.…”

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confidence: 99%

Transradial approach for mechanical thrombectomy in anterior circulation large-vessel occlusion

Sur

Snelling

Khandelwal

et al. 2017

FOC

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OBJECTIVE The goals of this study were to describe the authors' recent institutional experience with the transradial approach to anterior circulation large-vessel occlusions (LVOs) in acute ischemic stroke patients and to report its technical feasibility. METHODS The authors reviewed their institutional database to identify patients who underwent mechanical thrombectomy via a transradial approach over the 2 previous years, encompassing their experience using modern techniques including stent retrievers. RESULTS Eleven patients were identified. In 8 (72%) of these patients the right radial artery was chosen as the primary access site. In the remaining patients, transfemoral access was initially attempted. Revascularization (modified Treatment in Cerebral Ischemia [mTICI] score ≥ 2b) was achieved in 10 (91%) of 11 cases. The average time to first pass with the stent retriever was 64 minutes. No access-related complications occurred. CONCLUSIONS Transradial access for mechanical thrombectomy in anterior circulation LVOs is safe and feasible. Further comparative studies are needed to determine criteria for selecting the transradial approach in this setting.

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confidence: 99%

Transradial approach for mechanical thrombectomy in anterior circulation large-vessel occlusion

Sur

Snelling

Khandelwal

et al. 2017

FOC

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“…approach was chosen only for patients who switched from unsuccessful TFA. [4][5][6] Haussen et al 4) reported 15 patients who underwent endovascular treatment for acute ischemic stroke via the TRA. In 12 of these, the TFA was unsuccessful, requiring a switch to the TRA.…”

Section: Resultsmentioning

confidence: 99%

“…According to several studies, the route was changed, or the use of devices was devised in such patients. [3][4][5][6]11) Of patients with pc-LVO, the prognosis becomes unfavorable in approximately 90% when recanalization is not achieved. On the other hand, recent studies indicated that the endovascular treatment related effective recanalization rate was approximately 70%-80%, and that a favorable outcome was achieved in 30%-40%.…”

Section: Discussionmentioning

confidence: 99%

“…1,2) With respect to thrombectomy or the recanalization rate, favorable results have been consistently obtained, but we have often encountered patients in whom it was difficult to guide a guiding catheter into an occluded blood vessel, with an increase in the number of patients to be treated by this therapy. [3][4][5][6] Several studies reported that recanalization should be promptly performed to treat posterior circulation large vessel occlusion (pc-LVO), as indicated for the anterior circulation. 7,8) However, when selecting the transfemoral approach (TFA) for patients in whom an approach to the right vertebral artery (VA) is necessary, a specific interval is sometimes required until reaching due to the tortuosity of the aortic arch.…”

Section: Introductionmentioning

confidence: 99%

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Transradial Approach for Mechanical Thrombectomy of Posterior Circulation Stroke

Mizokami

Uwatoko

Furukawa

et al. 2018

NOUSHINKEI KEKKANNAI TIRYOU

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Objective: We report the mechanical thrombectomy (MT) of posterior circulation large vessel occlusion (pc-LVO) in which the transradial approach (TRA) was selected as an initial approach route to reduce the duration of treatment.Case Presentation: We performed MT using the TRA for four patients with pc-LVO between November 2015 and March 2017. The TRA was used as an initial approach route in patients in whom preoperative MRI showed that the right vertebral artery (VA) was predominant. In all patients, the procedure could be accomplished without changing the approach route. Thrombolysis in Cerebral Infarction (TICI) 2b or better recanalization was achieved in all patients (100%), and TICI 3 recanalization in three patients (75%). Mean time from radial artery puncture to initial intracranial angiography and to the effective recanalization was 7.3 ± 1.5 and 28.8 ± 6.2 minutes, respectively. There was no complication at the site of puncture. Conclusion:Recanalization was promptly and effectively achieved by the MT of pc-LVO using the TRA. The results suggest that TRA can be utilized as an initial access route in patients in whom an approach to the right VA is possible.

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“…From the viewpoint of treatment time, a transcervical access may be a final countermeasure. Haussen et al 20) reported the usefulness of a trans-radial-artery approach for acute mechanical thrombectomy in patients in whom a transfemoral-artery approach is difficult due to anatomical factors of the inguinal region and aortic arch. Of 1001 patients, a trans-radial-artery approach was adopted in 15 patients (1.5%).…”

Section: Discussionmentioning

confidence: 99%

Balloon-inflation Anchoring Technique for Insertion of a Guiding Catheter in Acute Mechanical Thrombectomy

Tokunaga

Tsurusaki

Sambongi

et al. 2017

NOUSHINKEI KEKKANNAI TIRYOU

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Purpose: Anatomical factors involved in the difficulty of inserting a guiding catheter (GC) into the aortic arch include marked arteriosclerosis with severe vessel tortuosity and type-3/bovine aortic arches. For patients with such factors, we have inserted a balloon guiding catheter (BGC) using the balloon-inflation anchoring technique (BIAT). In this study, we introduce the BIAT, and examine its usefulness. Subjects and Methods:The subjects were 44 patients who underwent acute mechanical thrombectomy for occlusion of the major cerebral artery in anterior circulation between January 2014 and February 2016. Of these, the BIAT was used for BGC insertion in patients, with the above anatomical factors, in whom it was difficult to insert a BGC using the standard method. The BIAT is a technique with a BGC in which an inner catheter is guided to the peripheral side by dilating/anchoring a balloon at maximum at the origin of the brachiocephalic trunk or left common carotid artery, and, subsequently, a BGC is guided to the target blood vessel by slightly deflating the balloon as a flow-guide. Results:Of the 44 patients, BGC insertion was difficult in eight patients (18%). The mean age of the other patients (control group) was 68.9 years, whereas that of the eight patients was 79.7 years, being significantly more advanced (p = 0.025). The BIAT facilitated BGC insertion in all patients, and the technical success rate was 100%. There were no procedure-related complications. The mean interval from the start of femoral artery puncture until BGC insertion was 15.7 and 20.3 minutes, respectively, in the control and BIAT groups. There was no significant difference between the two groups (p = 0.35). Conclusion:In 18% of patients who underwent acute mechanical thrombectomy, BGC insertion was difficult. In this group, the proportion of elderly patients was significantly higher. The BIAT facilitated BGC insertion in all patients. The mean interval from the start of puncture until BGC insertion was 20 minutes; a BGC could be guided in a relatively short period. This procedure may be particularly useful for acute mechanical thrombectomy, of which the duration directly contributes to the outcome.Keywords▶ balloon-inflation anchoring technique, bovine aortic arch, type-3 aortic arch, acute ischemic stroke, thrombectomy

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Transradial access in acute ischemic stroke intervention

Cited by 91 publications

References 13 publications

Transradial approach for mechanical thrombectomy in anterior circulation large-vessel occlusion

Transradial approach for mechanical thrombectomy in anterior circulation large-vessel occlusion

Transradial Approach for Mechanical Thrombectomy of Posterior Circulation Stroke

Balloon-inflation Anchoring Technique for Insertion of a Guiding Catheter in Acute Mechanical Thrombectomy

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