1
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Salem MM, Sioutas GS, Gajjar A, Khalife J, Kuybu O, Carroll KT, Hoang AN, Baig AA, Salih M, Baker C, Cortez GM, Abecassis Z, Ruiz Rodriguez JF, Davies JM, Cawley CM, Riina H, Spiotta AM, Khalessi A, Howard BM, Hanel RA, Tanweer O, Tonetti D, Siddiqui AH, Lang M, Levy EI, Ogilvy CS, Srinivasan VM, Kan P, Gross BA, Jankowitz B, Levitt MR, Thomas AJ, Grandhi R, Burkhardt JK. Femoral versus radial access for middle meningeal artery embolization for chronic subdural hematomas: multicenter propensity score matched study. J Neurointerv Surg 2024:jnis-2024-021880. [PMID: 38991734 DOI: 10.1136/jnis-2024-021880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/23/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND With transradial access (TRA) being more progressively used in neuroendovascular procedures, we compared TRA with transfemoral access (TFA) in middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH). METHODS Consecutive patients undergoing MMAE for cSDH at 14 North American centers (2018-23) were included. TRA and TFA groups were compared using propensity score matching (PSM) controlling for: age, sex, concurrent surgery, previous surgery, hematoma thickness and side, midline shift, and pretreatment antithrombotics. The primary outcome was access site and overall complications, and procedure duration; secondary endpoints were surgical rescue, radiographic improvement, and technical success and length of stay. RESULTS 872 patients (median age 73 years, 72.9% men) underwent 1070 MMAE procedures (54% TFA vs 46% TRA). Access site hematoma occurred in three TFA cases (0.5%; none required operative intervention) versus 0% in TRA (P=0.23), and radial-to-femoral conversion occurred in 1% of TRA cases. TRA was more used in right sided cSDH (58.4% vs 44.8%; P<0.001). Particle embolics were significantly higher in TFA while Onyx was higher in TRA (P<0.001). Following PSM, 150 matched pairs were generated. Particles were more utilized in the TFA group (53% vs 29.7%) and Onyx was more utilized in the TRA group (56.1% vs 31.5%) (P=0.001). Procedural duration was longer in the TRA group (median 68.5 min (IQR 43.1-95) vs 59 (42-84); P=0.038), and radiographic success was higher in the TFA group (87.3% vs 77.4%; P=0.036). No differences were noted in surgical rescue (8.4% vs 10.1%, P=0.35) or technical failures (2.4% vs 2%; P=0.67) between TFA and TRA. Sensitivity analysis in the standalone MMAE retained all associations but differences in procedural duration. CONCLUSIONS In this study, TRA offered comparable outcomes to TFA in MMAE for cSDH in terms of access related and overall complications, technical feasibility, and functional outcomes. Procedural duration was slightly longer in the TRA group, and radiographic success was higher in the TFA group, with no differences in surgical rescue rates.
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Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Avi Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Khalife
- Department Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Okkes Kuybu
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kate T Carroll
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alex Nguyen Hoang
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Mira Salih
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Cordell Baker
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Gustavo M Cortez
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Zack Abecassis
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - C Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Howard Riina
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexander Khalessi
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ricardo A Hanel
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel Tonetti
- Department Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Michael Lang
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Bradley A Gross
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ajith J Thomas
- Department Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Jan Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Marangoni M, Macdonald IR, Pickett GE, Weeks A, Kim CN, Rohr A, Guest W, Heran MKS, Volders D. Practical uses of the BENCHMARK™ BMX®81 in the road less travelled: Guide catheter comparison for radial access in neurovascular intervention. Interv Neuroradiol 2024:15910199241261756. [PMID: 38874547 DOI: 10.1177/15910199241261756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Radial arterial access has gained interest for neurovascular procedures in recent years. Although there are no randomized control trials for neurointervention procedures using radial access, there is growing literature demonstrating its feasibility and favorable outcomes. Equipment technical improvements, like the recently introduced BENCHMARK™ BMX®81 System, have made radial navigation safer, with improved maneuverability and support for a variety of procedures. We present a multicenter case series highlighting our institutional radial access experience comparing the BMX®81 with alternative catheters. METHODS Multicenter retrospective cohort study of 80 patients who underwent neurovascular procedures through a radial approach. In half of the cases a BENCHMARK™ BMX®81 System was used. The comparison group consisted of the BENCHMARK™071 and 96, Neuron MAX®088 and BALLAST™ systems. Procedures included endovascular thrombectomy, carotid and brachiocephalic artery stenting, middle meningeal artery embolization, flow diverter stenting, vertebral artery sacrifice, aneurysm coiling, and WEB™ device deployment. RESULTS In our series, the BMX®81 was successful in the navigation of the anatomy to the target location in 95% of cases. No radial access or BMX®81 related complications were identified. There was no significant difference in fluoroscopy time between the BMX81 and the comparison group. Four patients in the comparison group had catheter-related complications due to vasospasm. Eighty-six percent of BMX®81 cases had satisfactory outcomes and no technical difficulties. The remainder presented technical difficulties, but none of these were considered secondary to the puncture site or support structure. CONCLUSIONS The BENCHMARK™ BMX®81 System is a recently developed guiding catheter which has design and size features supporting radial access for a variety of neurovascular interventions. Early multicenter experience highlights the ease of use and versatility of this new catheter as an alternative to transfemoral access as well as other catheters used for radial access.
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Affiliation(s)
- Marco Marangoni
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Ian R Macdonald
- Division of Neuroradiology, Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Gwynedd E Pickett
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Adrienne Weeks
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Cha-Ney Kim
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Axel Rohr
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - William Guest
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Manraj K S Heran
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - David Volders
- Division of Neuroradiology, Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
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Hanaoka Y, Abe D, Koyama JI, Nakamura T, Kitamura S, Horiuchi T. A new very-small-bore Simmons guiding sheath for transradial neurointervention: Technical note and initial experience. J Neuroradiol 2024; 51:214-219. [PMID: 37625629 DOI: 10.1016/j.neurad.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/22/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
Transradial access during neurointerventions has increased in popularity because of reduced complications and patient preference. Nevertheless, transradial cannulation into the left common carotid artery can be difficult technically because of the lack of catheter support in the aortic arch. Furthermore, the use of large sheaths can increase the risk of complications at the access site. Here, we developed a new very-small-bore transradial system using a 3F Simmons guiding sheath, to increase the procedural success rate and minimize access-site complications. This system can represent a valuable treatment option for neurointerventions and has the potential to expand the indications for transradial access.
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Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan.
| | - Daishiro Abe
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Satoshi Kitamura
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
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4
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Morsi RZ, Kothari SA, Thind S, Desai H, Polster SP, Goldenberg F, Coleman E, Brorson JR, Mendelson S, Mansour A, Prabhakaran S, Kass-Hout T. The Zoom RDL radial access system for neurointervention: An early single-center experience. J Neurointerv Surg 2024; 16:266-271. [PMID: 37236781 DOI: 10.1136/jnis-2023-020153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The transradial approach (TRA) for neurointerventional procedures is increasingly being used given its technical feasibility and safety. However, catheter trackability and device deliverability are reported barriers to TRA adoption. METHODS This is the first report describing the technical feasibility and performance of using the Zoom RDL Radial Access System (Imperative Care, Inc., Campbell, CA) in 29 patients who underwent neurointerventional procedures from October 2022 to January 2023 in a single-center institution. RESULTS Mean age of the study population was 61.9±17.2 years, 79.3% were male (23/29), and 62.1% were black (18/29). The most common procedures were stroke thrombectomy (31.0%, 9/29) and aneurysm embolization (27.6%, 8/29). All the stroke thrombectomy procedures were successfully performed; first-pass effect rate (mTICI≥2 c in one pass) was achieved in 66.7% (6/9) of cases. We used TRA in 86.2% of cases (25/29), including distal radial/snuffbox access in 31.0% (9/29) of cases. The radial diameter was >2 mm for all cases. An intermediate/aspiration catheter was used in 89.7% (26/29) of cases. Access success was achieved in 89.7% of cases (26/29); two cases required conversion from TRA to transfemoral approach (6.9%) and one case required conversion to a different guide catheter (3.4%). There were no access site complications or other Zoom RDL-related complications. One intracerebral hemorrhage, and one procedure-related thrombus were observed. CONCLUSIONS The use of Zoom RDL Radial Access System is technically feasible and effective for complex neurointerventional procedures with low complication rates.
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Affiliation(s)
- Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sachin A Kothari
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sonam Thind
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Harsh Desai
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sean P Polster
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago, Chicago, Illinois, USA
| | | | - Elisheva Coleman
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - James R Brorson
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Scott Mendelson
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Ali Mansour
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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5
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Gao Y, Liu B, Yang H, Wang G, Huang J, Li C, Zhao P, Yang L, Yang Z. Comparison of Transradial Access and Transfemoral Access for Diagnostic Cerebral Angiography in the Elderly Population. World Neurosurg 2024; 181:e411-e421. [PMID: 37858864 DOI: 10.1016/j.wneu.2023.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Evaluate the efficacy, safety, and patient satisfaction of transradial access (TRA) compared with conventional transfemoral access (TFA) for diagnostic cerebral angiography in elderly patients (≥65 years of age). METHODS We performed a retrospective review of patients receiving cerebral angiography via TRA or TFA between October 2020 and December 2021 at 3 institutions. Basic patient characteristics, angiographic data, postoperative complications, and patient satisfaction were collected for analysis. RESULTS Of the 357 enrolled elderly patients, 175 were performed through TRA and 182 were performed through TFA. There was no significant difference in mean fluoroscopy time (8.6 ± 3.8 minutes vs. 9.1 ± 3.1 minutes; P = 0.103) and radiation exposure (47.7 ± 10.8 Gy-cm2 vs. 49.8 ± 11.3 Gy-cm2; P = 0.068) between the TRA and TFA groups. However, the TRA group had a shorter procedural time (54.7 ± 6.2 minutes vs. 61.1 ± 5.6 minutes; P < 0.001) and less contrast agent (83.2 ± 28.1 mL vs. 100.1 ± 26.2 mL; P < 0.001) than the TFA group. In terms of safety, the incidence of minor vascular access complications in the TRA group was lower than that in the TFA group (1.7% vs. 8.8%; P = 0.003). The incidence of serious complications and neurologic complications in the TRA group was also lower, although the difference was not statistically significant. Overall patient satisfaction was higher in the TRA group than that in the TFA group. CONCLUSIONS TRA was an efficient and safe alternative to conventional TFA in elderly patients who underwent diagnostic cerebral angiography and who underwent TRA were more satisfied. Findings supported the radial-first strategy for cerebral angiography in elderly populations.
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Affiliation(s)
- Yang Gao
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Bin Liu
- Department of Neurology, Minhang Central Hospital, Shanghai, China; Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hantao Yang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Guiping Wang
- Department of Neurology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jinlong Huang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Puyuan Zhao
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Liangliang Yang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhigang Yang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China; Department of Neurosurgery, National Clinical Research Center for Interventional Medicine of China, Shanghai, China.
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6
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Lauzier DC, Conway AP. Complications and risk factors after digital subtraction angiography: 1-year single-center study. J Cerebrovasc Endovasc Neurosurg 2023; 25:473-474. [PMID: 37423719 PMCID: PMC10774678 DOI: 10.7461/jcen.2023.e2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- David C. Lauzier
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, USA
| | - Alexander P. Conway
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, USA
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7
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Allard J, Shotar E, Premat K, Lenck S, Boch AL, Drir M, Sourour NA, Clarençon F. Radial artery occlusion after aneurysm treatment using the rist guide catheter: Single center cohort study. J Neuroradiol 2023:S0150-9861(23)00266-3. [PMID: 37984704 DOI: 10.1016/j.neurad.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND AND PURPOSE Delayed radial artery occlusion (dRAO) is a frequent complication after transradial access (TRA) for neurointervention when using standard large guide catheters. The RIST 079 guide catheter (RIST GC) is the first catheter designed for TRA in neurointervention. We aimed to assess the rate of dRAO after intracranial aneurysm (IA) treatment using the RIST GC. METHODS Patients treated for an IA using TRA and the RIST GC between June 2021 and November 2022 were referred to a systematic US-doppler assessment of the radial artery patency at 3-month follow-up. Patients with and without dRAO were compared to identify risk factors. RESULTS Twenty-two patients were included in the analysis. At 3-months follow up, 6 patients (27.3 %) presented with dRAO. Four patients were asymptomatic and 2 experienced post-operative radial hematoma and wrist pain. There was a tendency towards younger age, longer procedure duration and higher rate of forearm hematoma in patients with dRAO. Navigation using the RIST GC was successful in 90.9 % of cases. Intracranial access failures and navigation complications were all related to left internal carotid artery navigation. CONCLUSIONS At 3-month follow up, 27.3 % of patients treated for IA using TRA with the RIST GC presented dRAO.
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Affiliation(s)
- Julien Allard
- Department of Neuroradiology, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France.
| | - Eimad Shotar
- Department of Neuroradiology, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Kévin Premat
- Department of Neuroradiology, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Mehdi Drir
- Department of Anesthesiology and Neuro-intensive care, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
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8
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Imaoka Y, Kohyama S, Iijima S, Sato H, Yoshikawa S, Nakagami T, Mukasa A, Kurita H. Simplified Transradial Access for Aneurysms Treatment: A Guiding System Using Solo Distal Access Catheter and Anatomical Considerations. World Neurosurg 2023; 179:e444-e449. [PMID: 37660842 DOI: 10.1016/j.wneu.2023.08.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The recent shift from transfemoral access to transradial access in neurointervention has led to gaps in guiding systems. We propose a useful guiding system, the solo distal access catheter system without a conventional guiding catheter or a sheath in transradial access for aneurysms treatment. We also assessed the anatomical features required for suitable patient selection. METHODS We retrospectively collected data from consecutive patients with aneurysms treated with the solo distal access catheter system at our institution between April 2022 and April 2023, and evaluated the anatomical factors that appeared to affect the procedure. RESULTS Of the 20 patients who underwent transradial access, 11 were treated using the solo distal access catheter system, and 10 (90.9%) completed the procedure. No radial artery occlusion was detected. The entry angle of the target vessel ranged from 37° to 139°, and the mean proximal parent artery diameter was 9.34 ± 1.48 mm. A double subclavian innominate curve was observed in 3 of 5 patients whose target vessels were the right common carotid artery. CONCLUSIONS Using a solo distal access catheter as a guiding system for treating aneurysm proved effective and feasible with appropriate patient selection. Anatomical assessment of the entry angle of the target vessel, proximal parent artery diameter, and tortuosity may be important factors for the success of this method.
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Affiliation(s)
- Yukihiro Imaoka
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center 1397-1 Yamane, Saitama, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, Japan.
| | - Shinya Kohyama
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center 1397-1 Yamane, Saitama, Japan
| | - Shohei Iijima
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center 1397-1 Yamane, Saitama, Japan
| | - Hiroki Sato
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center 1397-1 Yamane, Saitama, Japan
| | - Shinichiro Yoshikawa
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center 1397-1 Yamane, Saitama, Japan
| | - Toru Nakagami
- Department of Neurology, Saitama Medical University International Medical Center 1397-1 Yamane, Saitama, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center 1397-1 Yamane, Saitama, Japan
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9
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Catapano JS, Winkler EA, Srinivasan VM, Dishion EL, Rutledge C, Baranoski JF, Cole TS, Rudy RF, Rumalla K, Zomaya MP, Jadhav AP, Ducruet AF, Albuquerque FC. Retained radial catheters associated with variant radial anatomy in neurointerventional procedures. J Neurointerv Surg 2023; 15:858-863. [PMID: 36190952 DOI: 10.1136/jnis-2022-019004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Transradial artery access (TRA) for neurointerventional procedures is gaining widespread acceptance. However, complications that were previously rare may arise as TRA procedures increase. Here we report a series of retained catheter cases with a literature review. METHODS All patients who underwent a neurointerventional procedure during a 23-month period at a single institution were retrospectively reviewed for a retained catheter in TRA cases. In cases of retained catheters, imaging was reviewed for anatomical variances in the radial artery, and clinical and demographic case details were analyzed. RESULTS A total of 1386 nondiagnostic neurointerventional procedures were performed during the study period, 631 (46%) initially via TRA. The 631 TRA cases were performed for aneurysm embolization (n=221, 35%), mechanical thrombectomy (n=116, 18%), carotid stent/angioplasty (n=40, 6%), arteriovenous malformation embolization (n=38, 6%), and other reasons (n=216, 34%). Thirty-nine (6%) TRA procedures crossed over to femoral access, most commonly because the artery of interest could not be catheterized (26/39, 67%). A retained catheter was identified in five cases (1%), and one (0.2%) patient had an entrapped catheter that was recovered. All six patients with a retained or entrapped catheter had aberrant radial anatomy. CONCLUSION Retained catheters for neurointerventional procedures performed via TRA are rare. However, this complication may be associated with variant radial anatomy. With the increased use of TRA for neurointerventional procedures, awareness of anatomical abnormalities that may lead to a retained catheter is necessary. We propose a simple protocol to avoid catheter entrapment, including in emergent situations such as TRA for stroke thrombectomy.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Ethan A Winkler
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Evan L Dishion
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Robert F Rudy
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Martin P Zomaya
- The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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10
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Romeo D, Salem MM, Sioutas GS, Corral Tarbay A, Ng JJ, Aboutaleb PE, Srinivasan VM, Pukenas B, Jankowitz BT, Burkhardt JK. The impact of Verapamil for radial access in diagnostic cerebrovascular angiograms: A retrospective case-control study. Interv Neuroradiol 2023:15910199231193932. [PMID: 37574785 DOI: 10.1177/15910199231193932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Different combinations of medications are utilized during wrist access for radial artery (RA) or ulnar artery (UA) catheterization in neuroendovascular procedures to preclude vasospasm. These "cocktails" commonly include the calcium channel blocker Verapamil, without established benefit. We analyze outcomes in patients with and without Verapamil in their "cocktail" by using a case-control cohort of our single-center experience. METHODS A prospective log of consecutive patients who underwent diagnostic cerebral angiograms using RA/UA access was retrospectively reviewed, and patients were grouped into Verapamil and non-Verapamil cohorts. The primary outcomes assessed were the presence of forearm skin rashes (hives) and RA/UA spasms. Our initial management included Verapamil (5 mg) in the cocktail, but Verapamil was removed after we noticed the development of hives in multiple patients immediately following its injection. RESULTS A total of 221 patients underwent 241 RA/UA diagnostic cerebral angiograms and were included in our analysis. One hundred and forty-nine patients (61.8%) underwent catheterization with Verapamil and 92 (38.2%) were catheterized without it. Four of the 149 patients in the Verapamil group (2.7%) developed hives during the procedure and were treated with Benadryl (25 mg). Of the 92 patients who did not receive Verapamil, there were zero (0%) cases of hives and one (1.1%) case of vasospasm. CONCLUSION Verapamil in the "cocktail" for wrist access diagnostic cerebral angiograms was associated with periprocedural hives, but not associated with a significant reduction in spasm compared to the non-Verapamil group. Our findings suggest that the administration of prophylactic Verapamil for these procedures may not be necessary.
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Affiliation(s)
- Dominic Romeo
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Antonio Corral Tarbay
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jinggang Jenny Ng
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Pakinam E Aboutaleb
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Bryan Pukenas
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
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11
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Luther E, McCarthy D, Hect J, Burks J, Lu VM, Govindarajan V, Ramsay IA, King H, Silva MA, Abdelsalam A, Yavagal D, Peterson E, Starke RM, Morcos J. Transradial Access Failures During Neuroangiography for Patients With Moyamoya. Neurosurgery 2023; 93:366-372. [PMID: 36847520 PMCID: PMC10586839 DOI: 10.1227/neu.0000000000002421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/27/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Despite studies continuing to demonstrate the utility of transradial access (TRA) in neuroangiography, minimal data exist regarding predictors of TRA failure. Furthermore, although many patients with moyamoya disease/syndrome will require life-long angiographic evaluation, even less has been reported on the usage of TRA in this population. OBJECTIVE To perform a matched analysis at our high-volume moyamoya center to determine predictors of TRA failure in these patients. METHODS A total of 636 patients undergoing TRA for neuroangiography were identified from 2018 to 2020. Demographic and angiographic characteristics including radial artery spasm (RAS), radial anomalies, and access site conversion were compared between patients with moyamoya and the rest of the cohort. A 4:1 matched analysis, based on age and sex, was also performed to eliminate confounding variables. RESULTS Patients with moyamoya were younger (40 vs 57 years, P < .0001), had smaller radial diameters (1.9 vs 2.6 mm, P < .0001), more commonly had a high brachial bifurcation (25.9% vs 8.5%, P = .008), more frequently experienced clinically significant RAS (40% vs 8.4%, P < .0001), and more often required access site conversion (26.7% vs 7.8%, P = .002). Increasing age was associated with less TRA failures in patients with moyamoya (odds ratio = 0.918) but more failures in the rest of the cohort (odds ratio = 1.034). In the matched analysis, patients with moyamoya continued to experience more radial anomalies, RAS, and access site conversions. CONCLUSION Patients with moyamoya, when controlling for age and sex, have higher rates of TRA failure during neuroangiography. Increasing age in Moyamoya is inversely correlated with TRA failures suggesting that younger patients with moyamoya are at higher risk of extracranial arteriopathy.
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Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David McCarthy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jasmine Hect
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joshua Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor M. Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vaidya Govindarajan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ian A. Ramsay
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hunter King
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael A. Silva
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ahmed Abdelsalam
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dileep Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eric Peterson
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert M. Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jacques Morcos
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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12
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Hampson R, Lawley A, Dobie G. Phantom Study of Arterial Localization using Tactile Sensor Array and a Normal Vs. Shear Pulse Pressure Propagation Method. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082657 DOI: 10.1109/embc40787.2023.10340678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Locating the radial artery reliably is a key challenge in reducing patient risks from complications in Trans-Radial Access, which is an important clinical method for catheterization, cardiac monitoring, and neuroendovascular procedures. New tactile sensing technology is being developed to bridge the skill, cost, and performance gap between ultrasonic needle guidance, and manual palpation, for use in developing countries. This paper further develops tactile artery localization with a novel algorithm for arterial localization based on the properties of a curved tactile sensor array. METHODS Using tactile sensor insensitivity to shear loading, coupled with a radial pulse wave propagation path, the position of the artery can be found at the intersection of a normal and tangential vector from the array corresponding to maximum and minimum pulse pressure measurement locations respectively. This was validated in a simple silicone phantom study Results: The proposed method measured with MAE= 0.58±0.25mm whilst the artery is within range of the tactile array, compared with 0.81±0.57mm for a comparative method of simple pulse localization. This showed improvement in arterial localization and repeatability, and was within 1 arterial radius, expected to reduce the risk of missing the artery, or perforating the side wall.Clinical Relevance- Robust and repeatable arterial localization is important for reducing the failure rate of trans-radial (and other arterial) procedures, and thus reducing the risk of harmful complications.
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13
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Dhillon PS, Butt W, Podlasek A, Bhogal P, McConachie N, Lenthall R, Nair S, Malik L, Lynch J, Goddard T, Barrett E, Krishnan K, Dineen RA, England TJ. Effect of proximal blood flow arrest during endovascular thrombectomy (ProFATE): Study protocol for a multicentre randomised controlled trial. Eur Stroke J 2023; 8:581-590. [PMID: 37231682 DOI: 10.1177/23969873231166194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Observational studies have demonstrated improved outcomes with the adjunctive use of balloon guide catheters (BGC) during endovascular thrombectomy (EVT) for anterior circulation acute ischaemic stroke (AIS). However, the lack of high-level evidence and global practice heterogeneity justifies a randomised controlled trial (RCT) to investigate the effect of transient proximal blood flow arrest on the procedural and clinical outcomes of patients with AIS following EVT. HYPOTHESIS Proximal blood flow arrest in the cervical internal carotid artery during EVT for proximal large vessel occlusion is superior to no flow arrest in achieving complete vessel recanalisation. METHODS ProFATE is an investigator-initiated, pragmatic, multicentre RCT with blinding of participants and outcome assessment. An estimated 124 participants with an anterior circulation AIS due to large vessel occlusion, an NIHSS of ⩾2, ASPECTS ⩾ 5 and eligible for EVT using a first-line combined technique (contact aspiration and stent retriever) or contact aspiration only will be randomised (1:1) to receive BGC balloon inflation or no inflation during EVT. OUTCOMES The primary outcome is the proportion of patients achieving near-complete/complete vessel recanalisation (eTICI 2c-3) at the end of the EVT procedure. Secondary outcomes include the functional outcome (modified Rankin Scale at 90 days), new or distal vascular territory clot embolisation rate, near-complete/complete recanalisation after the first pass, symptomatic intracranial haemorrhage, procedure-related complications and death at 90 days. DISCUSSION This is the first RCT to investigate the effect of proximal blood flow arrest during EVT using a BGC on the procedural and clinical outcomes of patients with AIS due to large vessel occlusion.
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Affiliation(s)
- Permesh Singh Dhillon
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Waleed Butt
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Anna Podlasek
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee, UK
| | - Pervinder Bhogal
- Interventional Neuroradiology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Norman McConachie
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jeremy Lynch
- Interventional Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Tony Goddard
- Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Barrett
- Department of Research and Innovation (Medical Statistics), Manchester University NHS Foundation Trust, Manchester, UK
- Centre for Biostatistics, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Kailash Krishnan
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
| | - Robert A Dineen
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
- Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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14
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El Naamani K, Abbas R, Sioutas GS, Amllay A, Tjoumakaris S, Gooch MR, Rosenwasser RH, Jabbour P. A complication of the transradial approach: thyrocervical trunk pseudoaneurysm with hemothorax. BJR Case Rep 2023; 9:20220136. [PMID: 37265746 PMCID: PMC10230224 DOI: 10.1259/bjrcr.20220136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 06/03/2023] Open
Abstract
The transradial approach has gained popularity in the neuroendovascular field after several studies proved its low rate of hemorrhagic and vascular-related complications in both diagnostic and therapeutic procedures. This is a case of a patient who presented for flow diversion treatment of an incidental left carotid ophthalmic aneurysm. The procedure was uneventful. Post-operatively, the patient's neurological exam and vital signs were normal, however the patient complained of abdominal and chest pain that worsened when lying down and improved when sitting up. Radiologic diagnosis confirmed the presence of a thyrocervical trunk pseudoaneurysm which was completely obliterated with Onyx 18 embolization. Thyrocervical trunk pseudoaneurysm formation is a rare complication of the transradial approach. Shedding the light on these entities is essential as symptoms vary in severity and presentation and necessitate swift diagnosis and treatment.
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Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Abdelaziz Amllay
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael R Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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15
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Fuga M, Tanaka T, Tachi R, Wachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. A novel 3-Fr guiding sheath for transradial access in aneurysm embolization: Technical note. Interv Neuroradiol 2022:15910199221142093. [PMID: 36437634 DOI: 10.1177/15910199221142093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Neurointervention via transradial access (TRA) is challenging when the radial artery is narrow. We performed aneurysm embolization via TRA using a novel 3-Fr guiding sheath (GS) (Axcelguide; Medikit, Tokyo, Japan) with an outer diameter of only 1.76 mm for patients with a radial artery of inner diameter less than 2 mm, and described the whole procedure and pitfalls as a technical note. Here, we present two patients with radial arteries less than 2 mm. One patient had a narrow neck intracranial aneurysm at the bifurcation of the left vertebral artery and posterior inferior cerebellar artery, which was embolized with the primary coiling technique. The other was a patient with a wide-necked extracranial aneurysm in the cavernous portion of the right internal carotid artery, which was embolized with the transcell technique with stent. We utilized a 3-Fr GS, distal access catheter, and a 0.0165-inch microcatheter for coil embolization. All aneurysms were completely occluded, without neurological or puncture site-related complications including subcutaneous hematoma, radial artery occlusion, and vasospasm. This report provides the first description of neurointervention using a 3-Fr GS. The 3-Fr GS contributed to successful completion of TRA aneurysm embolization without neurological or puncture site-related complications in patients with radial arteries narrower than 2 mm. The 3-Fr GS may be useful to accomplish aneurysmal embolization via TRA even in patients with a small radial artery.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Ryoto Wachi
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, 12839Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, 12839Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, 12839Jikei University School of Medicine, Tokyo, Japan
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16
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Krothapalli N, Fayad M, Patel S, Elmashad A, Sussman E, Bruno C, Grande A, Jagadeesan B, Killory B, Alberts M, Kureshi I, Ollenschleger M, Tummala R, Mehta T. Use of reverse angle guide catheter with trans-radial approach in patients undergoing middle meningeal artery embolization. Front Neurol 2022; 13:990722. [DOI: 10.3389/fneur.2022.990722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTrans-radial access (TRA) for MMA embolization has grown due to lower access site complications and greater patient satisfaction. Here, we describe the feasibility of utilizing a 6F Envoy Simmons 2 (6F-SIM2) as a guide catheter with TRA and compare outcomes with trans-femoral approach (TFA) in a single center case series.MethodsWe performed a retrospective review of patients who underwent MMA embolization for management of chronic subdural hematoma (cSDH). TRA was performed by utilizing a combination of 6F 90cm Envoy (Codman & Shurtleff, Inc., Rayham, MA) Simmons 2 guide catheter and 5F 125cm Sofia (Microvention, Aliso Viejo, CA) intermediate catheter. Outcomes measured are Modified Rankin Score (mRS) at 90 days, inpatient mortality, post-embolization recurrence, fluoroscopy time and radiation exposure.ResultsA total of 71 patients underwent 97 MMA embolization overall with 65 (67%) in trans-femoral access group, 11 (11.3%) in trans-radial access without use of Simmons 2 Guide catheter group and 21 (21.6%) in trans-radial access with use of Simmons 2 Guide catheter group. There were no direct access-related complications in either group. One patient had thromboembolic stroke in trans-femoral group. There was no difference in average procedure-related total fluro time or radiation dose among all three groups.ConclusionTrans-radial approach using 6F-SIM2 guide catheter coupled with 5F Sofia intermediate catheter is safe and effective. It provides an alternative approach to access distal branches of bilateral anterior circulation in elderly patients with difficult anatomy undergoing MMA embolization.
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17
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Caton MT, Smith ER, Baker A, Dowd CF, Higashida RT. Transradial Approach for Thoracolumbar Spinal Angiography and Tumor Embolization: Feasibility and Technical Considerations. Neurointervention 2022; 17:100-105. [PMID: 35340197 PMCID: PMC9256468 DOI: 10.5469/neuroint.2022.00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
The transradial approach (TRA) is an effective and safe alternative to transfemoral access for diagnostic neuroangiography and craniocervical interventions. While the technical aspects of supraclavicular intervention are well-described, there are little data on the TRA for thoracolumbar angiography and intervention. The authors describe the feasibility of the TRA for preoperative thoracic tumor embolization, emphasizing technique, device selection, navigation, and catheterization of thoracolumbar segmental arteries. This approach extends the benefits of TRA to spinal interventional neuroradiology.
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Affiliation(s)
- Michael Travis Caton
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Eric Robert Smith
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Amanda Baker
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Foley Dowd
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA.,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Randall T Higashida
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA.,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
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18
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Narsinh KH, Mirza MH, Duvvuri M, Caton MT, Baker A, Winkler EA, Higashida RT, Halbach VV, Amans MR, Cooke DL, Hetts SW, Abla AA, Dowd CF. Radial artery access anatomy: considerations for neuroendovascular procedures. J Neurointerv Surg 2021; 13:1139-1144. [PMID: 34551992 DOI: 10.1136/neurintsurg-2021-017871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023]
Abstract
Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we will review important anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. These include normal and variant radial artery anatomy, the anatomic snuffbox, as well as axillary, brachial, and great vessel arterial anatomy that is imperative for the neuroendovascular surgeon to be intimately familiar prior to pursuing transradial access procedures. In the next part of the review series, we will focus on safety and complications specific to a transradial approach.
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Affiliation(s)
- Kazim H Narsinh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Mohammed H Mirza
- Department of Radiology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Madhavi Duvvuri
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - M Travis Caton
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Amanda Baker
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Randall T Higashida
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Van V Halbach
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Christopher F Dowd
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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