Usefulness of a Novel Technique to Make Up for a Deficiency in Transradial Neurointervention with a 6Fr Simmonds Guiding Sheath: Original Experience with the Subclavian Artery Anchoring Technique

Abstract

Background: The benefits of the right transradial approach for anterior circulation lesions using a 6F Simmonds guiding sheath have been reported. However, this technique can be anatomically challenging in the type I aortic arch. Furthermore, to the best of our knowledge, no studies have reported on neurointervention using a Simmonds guiding sheath and the left transradial approach. We devised a novel technique using the contralateral subclavian artery as an "anchor" to reform the Simmonds curve, named the subclavian artery anchoring technique (SCAT). The purpose of the present study was to evaluate the feasibility, safety, and usefulness of neurointervention with the SCAT for patients with a type I aortic arch treated with the right transradial approach and patients treated with the left transradial approach.

Methods: Ten consecutive patients treated from June 2018 to January 2019 were included in the present study. We retrospectively analyzed: 1) the success rate for reforming the Simmonds curve using the SCAT; 2) the success rate for introducing the 6F Simmonds guiding sheath into the target common carotid artery; 3) the success rate for completing the procedure; 4) periprocedural complications; and 5) vascular access site complications.

Results: In all 10 patients, the Simmonds curve was reformed, and a 6F Simmonds guiding sheath was introduced into the target common carotid artery. The procedure was successfully achieved for all 10 patients without periprocedural or vascular access site complications.

Conclusions: The results of the present study have shown that this technique is a feasible, safe, and useful method for patients with type I aortic arch treated with a right transradial approach or a left transradial approach. SCAT makes up for a deficiency in the transradial approach with a 6F Simmonds guiding sheath.

Keywords: Carotid artery stenting; Cerebral aneurysm coiling; Neuroendovascular treatment; Simmonds guiding sheath; Transradial approach; Vascular access.