Safety and feasibility of transradial use of 8F balloon guide catheter Flowgate2 for endovascular thrombectomy in acute ischemic stroke

Feasibility, efficacy, and safety of mechanical thrombectomy via sheathless transradial access as a first-line strategy: A case series

OBJECTIVE

Although mechanical thrombectomy (MT) is primarily performed via transfemoral access (TFA), transradial access (TRA) is a potential alternative in older patients or those with tortuous vessels. However, the small radial artery diameter restricts the use of large-bore balloon guides and aspiration catheters, a limitation that may be overcome using the sheathless technique. Thus, we aimed to explore the feasibility, efficacy, and safety of sheathless TRA-MT as a first-line treatment approach for acute ischemic stroke.

METHODS

This single-center retrospective case series included patients who underwent TRA-MT as first-line treatment between September 2020 and June 2023. Per our MT protocol, TRA was not the first-line approach in cases of left anterior circulation lesions with a type 3 aortic arch. We evaluated treatment effectiveness based on the successful recanalization rate, puncture-to-recanalization time, and modified first-pass effect; access route effectiveness based on the puncture-to-first-pass time and switch-to-TFA rate; and procedure safety based on procedure-related and severe puncture site complications.

RESULTS

Sheathless 8-F guide catheters were used in 68 % and large-bore aspiration catheters in 70 % of the procedures. Successful recanalization was achieved in 98 % of the patients, with a modified first-pass effect in 54 % of them. The median puncture-to-first-pass and puncture-to-recanalization times were 20.5 and 33 min, respectively. The rate of procedure-related complications was low (4 %), with no severe puncture site complications.

CONCLUSION

Sheathless TRA-MT enabled the use of large-bore guide and aspiration catheters, providing a swift approach to the target and satisfactory outcomes, and might be an effective first-line treatment for acute ischemic stroke.

The Zoom RDL radial access system for neurointervention: An early single-center experience

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.

Transradial Carotid Artery Stenting Using Walrus Balloon Guide Catheter: Technical Aspects and Clinical Outcome

BACKGROUND

Despite an overall surge in transradial access (TRA) for neurointerventional procedures, the feasibility and safety of TRA carotid artery angioplasty and stenting using balloon guide catheters (BGCs) through a short 8-Fr sheath have not been studied. In this study, we present our experience of using Walrus BGC through TRA for carotid artery stent placement.

OBJECTIVE

To define the safety and efficacy of using a balloon guide catheter for carotid stenting by a transradial approach.

METHODS

Our prospectively maintained retrospective database was reviewed, and consecutive patients were identified who underwent elective carotid artery stenting through TRA using Walrus BGC between January 2021 and June 2022. Demographics, procedural details including access site complications, the rate of radial to groin conversion, and procedure-related transient ischemic attack or stroke were reviewed.

RESULTS

Twenty patients were identified who underwent carotid artery angioplasty and stenting through TRA Walrus BGC use; the mean age was 66 years (range 42-89), and 67% were male. A short 8-Fr sheath was used in all patients without any complications. Two of 20 patients required TRA conversion to transfemoral access, both secondary to severe spasm of the radial artery after initial access inhibiting further advancement of the Walrus BGC.

CONCLUSION

Use of Walrus BGC by TRA through an 8-Fr sheath for carotid artery stenting is safe and feasible with a low rate of conversion to transfemoral access and no access site complications.

Transradial balloon guide catheter placement for acute ischemic stroke thrombectomy: A systematic review and meta-analysis

BACKGROUND

Endovascular thrombectomy (EVT) is a treatment option for acute ischemic stroke due to large vessel occlusion. The use of a balloon-guided catheter (BGC) for EVT via transradial access (TRA) has emerged as a treatment approach, but its efficacy and safety compared to existing practices are uncertain.

METHODS

A systematic literature review was performed using Embase, PubMed, Scopus, Web of Science databases, and manual search. Studies reporting safety and efficacy metrics for TRA BGC EVT were included. Data regarding recanalization time, thrombolysis in cerebral infarction (TICI), modified Rankin scale (mRS), symptomatic intracranial hemorrhage (sICH), first pass effect (FPE), and additional complications was pooled using a random-effects model to calculate event rates and 95% confidence intervals (CI).

RESULTS

The search yielded five studies (n  =  117). The mean time from puncture to final recanalization was 34.5 (95% CI  =  30.5 to 39.14, I²  =  0%, P-value  =  0.37) min. Successful recanalization (TICI 2b-3) and complete recanalization (TICI 3) occurred in 96.6% (95% CI  =  91.24 to 98.71, I²  =  0%, P-value  =  0.99) and 55.2% (95% CI  =  42.14 to 67.54, I²  =  0%, P-value  =  0.39) of cases, respectively. FPE occurred in 67.5% (95% CI  =  51.73 to 80.10, I²  =  0%, P-value  =  0.56) of patients. mRS 0-2 was achieved in 41.2% (95% CI  =  27.34 to 56.65, I²  =  70%, P-value  =  0.07) of patients. sICH occurred in 5.0% (95% CI  =  1.25 to 17.91, I²  =  0%, P-value  =  1.00) of patients. Local complications of radial hematoma and radial vasospasm occurred in 5.0% (95% CI  =  0.49 to 12.36, I²  =  29%, P-value  =  0.24) and 2.1% (95% CI  =  1.25 to 17.91, I²  =  71%, P-value  =  0.03) of cases, respectively. Switch to femoral access was necessary in 3.7% (95% CI  =  0.00 to 14.07, I²  =  68%, P-value  =  0.02) of procedures. The average number of passes per procedure was 1.6 (95% CI  =  1.15 to 2.11, I²  =  88%, P-value < 0.001).

CONCLUSION

TRA BGC EVT has potential as a safe and efficacious treatment option compared to existing methods. However, additional, prospective studies are necessary to inform clinical decision making.

Transradial Mechanical Thrombectomy Using a Radial-specific Neurointerventional Guiding Sheath for Anterior Circulation Large-Vessel Occlusions: Preliminary Experience and Literature Review

BACKGROUND

Transradial mechanical thrombectomy (MT) is increasingly used because it is associated with a low incidence of vascular access site complications. However, transradial carotid cannulation can be technically challenging to perform in patients with an unfavorable supra-aortic takeoff. In this study, the feasibility and safety of a new transradial MT system with a radial-specific neurointerventional guiding sheath-6F Simmons guiding sheath was evaluated-in patients with anterior circulation large-vessel occlusions. Additionally, a literature review was performed.

METHODS

We retrospectively analyzed data from our institutional database about consecutive patients who underwent transradial MT for anterior circulation large-vessel occlusion. After the 6F Simmons guiding sheath was engaged into the target common carotid artery, a triaxial system (Simmons guiding sheath/aspiration catheter/microcatheter), was established. MT using the continuous aspiration prior to intracranial vascular embolectomy technique was performed. Then, procedural success rate, successful revascularization, and procedure-related complications were assessed.

RESULTS

A total of 13 patients who had transradial MT were included in the analysis. All 13 patients underwent successful thrombectomy without catheter kinking or system instability, and 12 of them achieved successful revascularization (modified Thrombolysis in Cerebral Infarction score of ≥2b). No complications occurred.

CONCLUSIONS

To the best of our knowledge, this is the first case series on transradial MT using a radial-specific neurointerventional system for anterior circulation large-vessel occlusions. This method may increase the success rate of transradial MT. Based on our initial experience, transradial MT, using this system, was feasible and safe for anterior circulation large-vessel occlusions.

Use of a sheathless 8-French balloon guide catheter (Walrus) through the radial artery for mechanical thrombectomy: technique and case series

BACKGROUND

The effectiveness of transradial stroke thrombectomy has been limited by guide catheter size and lack of good balloon options. In this study we describe our technique for the use of a sheathless 8-French balloon guide catheter (Walrus) through radial access and present our initial clinical experience.

METHODS

This was a retrospective case series of consecutive patients who underwent mechanical thrombectomy for large vessel occlusion using the sheathless catheter over a period of 3 months. Clinical characteristics, procedural details, reperfusion success (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3 grade), first-pass effect (FPE; mTICI reperfusion grade 2c or 3 with a single pass), access site complications and clinical improvement at discharge were recorded. A descriptive analysis was performed.

RESULTS

Among the 10 patients in the series, median age was 77 years (IQR 75-79) and three were women. All patients had a baseline modified Rankin Scale score ≤2. Median admission National Institutes of Health Stroke Scale (NIHSS) score was 12.5 (IQR 9-16). Four patients received intravenous alteplase before mechanical thrombectomy. Eight patients had M1 occlusion and two had proximal M2 occlusion. The median radial artery diameter was 2.5 mm (IQR 2.5-2.7). Successful reperfusion was achieved in all patients. FPE was achieved in six patients. No access site-related complications or post-procedural intracranial hemorrhages occurred. All patients had improvement in NIHSS score at discharge.

CONCLUSIONS

The use of this sheathless catheter for transradial access was safe and feasible. The technique can potentially improve the outcomes of transradial access for stroke intervention.