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

Sur, Samir; Snelling, Brian; Khandelwal, Priyank; Caplan, Justin M.; Peterson, Eric C.; Starke, Robert M.; Yavagal, Dileep R.

doi:10.3171/2017.1.focus16525

Cited by 79 publications

(55 citation statements)

References 16 publications

(20 reference statements)

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“…A recent study by Chen et al has demonstrated equivalence in efficacy and efficiency between trans-radial and trans-femoral approach for mechanical thrombectomy in anterior circulation stroke,20 and there are reports in the literature of success through the trans-radial approach when a trans-femoral approach has failed 16. Trans-radial is preferred over trans-brachial as the puncture site is easily compressible.…”

Section: Discussionmentioning

confidence: 99%

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

Roche

Griffin

Looby

et al. 2019

J NeuroIntervent Surg

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BackgroundMechanical thrombectomy is the standard of care for acute ischemic strokes with proximal intracranial occlusion. Arterial access is commonly achieved with femoral artery puncture, although this is not always possible. In this case series, we describe 11 cases of anterior circulation stroke where direct carotid puncture was used to obtain vascular access.Methods and materialsA review of a prospectively maintained thrombectomy database over a 2-year period (August 2016 – August 2018) was undertaken to identify cases where direct carotid access was performed. CT and angiographic imaging were reviewed. Indications for carotid access, techniques used, technical success of procedure, recanalization rates, procedure-related complications, and patient outcomes were assessed.ResultsEleven patients out of 498 overall thrombectomy procedures (2.2% thrombectomies) underwent direct carotid access. Median National Institutes of Health Stroke Scale was 20. Seventy three percent of patients received intravenous thrombolysis. The direct carotid approach was performed following the failed femoral approach due to unfavorable aortic arch anatomy, vessel tortuosity, and severe atherosclerotic disease. Direct carotid puncture was successful in 10 patients, and unsuccessful in one. Successful recanalization (TICI 2b–3) was achieved in eight patients. One patient had spontaneously recanalized on angiography. There was failed recanalization in one patient with tandem ICA and M1 occlusion. Carotid access complications included one patient with both neck hematoma and asymptomatic ICA dissection, and one of delayed central retinal artery occlusion.ConclusionThis case series highlights direct carotid puncture as a successful alternative when the femoral approach is not possible, allowing thrombectomy in patients who would otherwise be unsuitable.

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Section: Discussionmentioning

confidence: 99%

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

Roche

Griffin

Looby

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

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“…The radial artery is relatively superficial, easy to cannulate, and convenient for hemostasis compared with the more challenging transbrachial route. The ease of hemostasis is particularly attractive in the setting of tPA or other coagulopathies, and transradial has been described as a firstline approach in acute ischemic stroke 52. The transbrachial approach offers similar access as the transradial approach in a larger caliber vessel which can then accommodate larger catheters, although hemostasis may be more difficult to achieve.…”

Section: Technical Considerationsmentioning

confidence: 99%

Neuroendovascular management of emergent large vessel occlusion: update on the technical aspects and standards of practice by the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery

Gandhi

Al‐Mufti

Singh

et al. 2018

J NeuroIntervent Surg

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“…Despite significant technological advances, catheterization of the craniocervical arteries can still be challenging. The inability to catheterize the targeted craniocervical vessels via the femoral artery approach has been reported in up to 5% of cases 3 4. The presence of vessel tortuosity and atherosclerosis can increase the complexity and duration of the procedure, and affect the clinical outcome 3 5…”

Section: Discussionmentioning

confidence: 99%

Balloon anchoring technique forthrombectomyin hostile craniocervical arterial anatomy

Sharashidze

Nogueira

Grossberg

et al. 2020

J NeuroIntervent Surg

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BackgroundCraniocervical catheter access in large vessel occlusion acute ischemic strokes can be challenging in cases of unfavorable aortic arch/cervical vascular anatomy, leading to lower recanalization rates, increased procedural time and worse clinical outcomes. We aim to demonstrate the feasibility of the balloon-anchoring technique (BAT) that can be attempted before switching to alternative access sites.MethodsRetrospective review of prospectively collected information on 11 patients in which two variants of the BAT (proximal anchoring: balloon guide catheter (BGC) is inflated to provide support for distal access; distal anchoring: compliant balloon is inflated in an intracranial artery to allow advancement of the support system) were utilized to facilitate craniocervical access due to failure of conventional maneuvers.ResultsTen patients had anterior and one patient had posterior circulation large vessel occlusions. Mean age was 81 years and 81% were females. Type 3 arches were found in 82% and a 9 French balloon guide catheter was used in 82%. Proximal anchoring with BGC was used in four cases while distal anchoring was used in seven patients to allow access to the target vessel, avoiding the need to puncture alternative access sites. Successful reperfusion (modified treatment in cerebral ischemia 2b-3) was achieved in all cases and no complications were observed.ConclusionBAT is safe and feasible. It can be considered as a rescue maneuver in order to avoid switching to a different access during thrombectomy in individuals with unfavorable aortic arch/craniocervical anatomy.

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

Cited by 79 publications

References 16 publications

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

Neuroendovascular management of emergent large vessel occlusion: update on the technical aspects and standards of practice by the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery

Balloon anchoring technique forthrombectomyin hostile craniocervical arterial anatomy

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