Transradial approach for endovascular diagnosis and treatment of ruptured cerebral aneurysms: A descriptive study

Goland, Javier; Doroszuk, Gustavo

doi:10.25259/sni-44-2019

Cited by 12 publications

(13 citation statements)

References 28 publications

(32 reference statements)

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“…[4] The procedure continues as described in previous articles on the diagnosis and treatment of cerebral aneurysms by the radial route. [3,4]…”

Section: Methodsmentioning

confidence: 99%

“…The transradial approach has emerged as a neurointerventional option for the diagnosis and treatment of cerebral aneurysms. [3-6,9,10] Comparative studies of patients who underwent radial or femoral cardiac catheterization have shown that the transradial approach results in fewer complications at the puncture site, lower hospital costs, and greater comfort for patients. [1,7]…”

Section: Introductionmentioning

confidence: 99%

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Distal radial approach for neurointerventional diagnosis and therapy

Goland¹,

Domitrovic²,

Doroszuk

et al. 2019

Surgical Neurology International

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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.

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“…[4] The procedure continues as described in previous articles on the diagnosis and treatment of cerebral aneurysms by the radial route. [3,4]…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distal radial approach for neurointerventional diagnosis and therapy

Goland¹,

Domitrovic²,

Doroszuk

et al. 2019

Surgical Neurology International

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“…A 60-year-old woman presented to our unit with a subarachnoid hemorrhage: Hunt Hess 4, Fisher 4 ( Figure 1 ). The patient was intubated, then a right radial approach was used to occlude the aneurism using a technique described in previous publications [ 4 , 5 ].…”

Section: Case Reportmentioning

confidence: 99%

Transradial Approach to Cerebral Aneurysm Occlusion in a Patient with an Aberrant Right Subclavian Artery: A Case Report

Goland

Doroszuk

2021

Am J Case Rep

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Patient: Female, 60-year-old Final Diagnosis: Subarachnoid hemorrhage Symptoms: Coma Medication: — Clinical Procedure: — Specialty: Neurosurgery Objective: Rare disease Background: Retroesophageal right subclavian artery, aberrant right subclavian artery, or lusoria artery constitutes an anatomical variation with a very low prevalence in the general population. Its presence in a patient does not add difficulty for cerebral arteries catheterization when a femoral approach is used, but may make the catheterization of cerebral vessels difficult when a right transradial approach is used. Unfortunately, this type of configuration of the artery is discovered after the decision to use the type of approach. Case Report: A 60-year-old woman with a diagnosed subarachnoid hemorrhage was studied with angiography through a transradial approach. A left carotid bifurcation aneurysm was diagnosed after three-vessel angiography was performed with a Simmons type 2 catheter, making a complete loop between the right subclavian artery, aortic arc, and left carotid artery. The ruptured cerebral aneurysm was completely occluded with 8 coils. The microcatheter used for the procedure emerged from the tip of an intermediate catheter located at the union of the vertical and horizontal segment of the petrous segment of the left carotid artery. Conclusions: The presence of an aberrant right subclavian artery during cerebral angiography performed through a right transradial approach renders the treatment of a left carotid cerebral aneurysms more difficult but not impossible. Utilizing an appropriate intermediate catheter allows for stable navigation of the microcatheter and complete treatment of the aneurysm. This is the first report of cerebral aneurysm embolization through a right transra-dial approach in a patient with an aberrant right subclavian artery.

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“…Furthermore, while transfemoral access has been the preferred approach during neurointerventional procedures for decades (6), recent studies have shown the promise of transradial access for the diagnosis and treatment of various cerebral pathologies with embolization, mechanical thrombectomy, microsurgical aneurysm clipping, stenting, and balloon occlusion tests (7)(8)(9). While studies of safety and efficacy of radial access are ongoing, a key and understudied aspect of this procedure is the feasibility of using current long guiding sheaths in this novel application across disease states.…”

Section: Introductionmentioning

confidence: 99%

Utilization of the Ballast Long Guiding Sheath for Neuroendovascular Procedures: Institutional Experience in 68 Cases

2021

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Background: The rise of neurointerventional devices has created a demand for guide systems capable of navigating to the carotid artery consistently regardless of tortuosity. The shift toward large distal access catheters (DACs) and desire for greater trackability have inspired the creation of flexible, supportive, large-lumen long guiding sheaths. Recently, the Ballast long guiding sheath was introduced to provide stability and flexibility while navigating neurointerventional devices through tortuous intracranial anatomy.Objective: To report our experience using the Ballast long guiding sheath in a series of patients undergoing a variety of neuroendovascular procedures.Methods: We retrospectively identified all patients who underwent neuroendovascular treatment with a long guiding sheath were selected from a prospectively maintained endovascular database from January 2019 to November 2019. Baseline clinical characteristics and procedural details were collected.Results: A total of 68 patients were included, mean patient age 67.6 ± 13.6 years. Of the patients treated, 52.9% (36/68) presented with stenosis, 25% (17/68) with aneurysms, 13.2% (9/68) with stroke or emboli, 1.5% (1/68) with a tumor, 1.5% (1/68) with an arteriovenous fistula (AVF), and 4.4% (3/68) with a carotid web. Of the patients with stenosis, 20/36 (55.6%) were extracranial, and 16/36 (44.4%) were intracranial. The Ballast long guiding sheath was used to deliver treatment devices for stenting (37/68, 54.4%), flow diversion (12/68, 17.6%), mechanical thrombectomy (8/68, 11.8%), endovascular coiling (5/68, 7.4%), liquid embolization (3/68, 4.4%), balloon angioplasty (2/68, 2.9%), and balloon angioplasty with stenting (1/68, 1.5%). No Ballast-related complications or adverse events were encountered.Conclusions: We demonstrate the feasibility of the Ballast long guiding sheath to successfully deliver modern neurointerventional treatment devices through tortuous anatomy.

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Transradial approach for endovascular diagnosis and treatment of ruptured cerebral aneurysms: A descriptive study

Cited by 12 publications

References 28 publications

Distal radial approach for neurointerventional diagnosis and therapy

Distal radial approach for neurointerventional diagnosis and therapy

Transradial Approach to Cerebral Aneurysm Occlusion in a Patient with an Aberrant Right Subclavian Artery: A Case Report

Utilization of the Ballast Long Guiding Sheath for Neuroendovascular Procedures: Institutional Experience in 68 Cases

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