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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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Manzoor MU, Alrashed AA, Almulhim IA, Alqahtani S, Senani FA. Ulnar artery access for intracranial mechanical thrombectomy procedure: A salvage option after failed trans-femoral and trans-radial access. J Cerebrovasc Endovasc Neurosurg 2023; 25:429-433. [PMID: 36800673 PMCID: PMC10774676 DOI: 10.7461/jcen.2023.e2022.10.012] [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: 10/16/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 02/21/2023] Open
Abstract
84 years old gentle man with past medical history of hypertension and diabetes presented with sudden onset right sided weakness and aphasia for two hours. Initial neurological assessment revealed National Institute of Health Stroke Scale (NIHSS) 17. Computed tomography (CT) scan demonstrated minimal early ischemic changes along left insular cortex with occlusion of left middle cerebral artery (MCA). Based on clinical and imaging findings, decision was made to perform mechanical thrombectomy procedure. Initially, right common femoral artery approach was utilized. However, due to unfavorable type-III bovine arch, left internal carotid artery could not be engaged via this approach. Subsequently, access was switched to right radial artery. Angiogram revealed small caliber radial artery, with larger caliber ulnar artery. Attempt was made to advance the guide catheter through the radial artery, however significant vasospasm was encountered. Subsequently, ulnar artery was accessed and successful thrombolysis in cerebral infarction (TICI) III left MCA reperfusion was achieved with a single pass of mechanical thrombectomy via this approach. Post procedure neurological examination demonstrated significant clinical improvement. Doppler ultrasound 48 hours after the procedure demonstrated patent flow in radial and ulnar arteries with no evidence of dissection.
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Affiliation(s)
- Muhammad U Manzoor
- Radiology Department, Diagnostic and Interventional Neuroradiology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah A Alrashed
- Radiology Department, Diagnostic and Interventional Neuroradiology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim A Almulhim
- Radiology Department, Diagnostic and Interventional Neuroradiology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sultan Alqahtani
- Radiology Department, Diagnostic and Interventional Neuroradiology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahmi Al Senani
- Neurology Department, Interventional Neuroradiology Section, King Fahad Medical City, Riyadh, Saudi Arabia
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