Transitioning to Transradial Access for Cerebral Aneurysm Embolization

Abstract

Background and purpose: Despite several retrospective studies showing the safety and efficacy of transradial access for cerebral angiography, neurointerventionalists are apprehensive about implementing TRA for neurointerventions. This reluctance is mainly due to anatomic factors, technical factors, and a long learning curve (relative to transfemoral access). We present here our experience of TRA transition for cerebral aneurysm embolization. Our aim was to demonstrate the feasibility and safety of radial access for consecutive embolizations of ruptured and unruptured cerebral aneurysms.

Materials and methods: We performed a retrospective review of a prospective data base on cerebral aneurysm embolizations. Between April and December 2018, radial access was considered for all consecutive patients referred to our institution for cerebral aneurysm embolization. Technical success was defined as radial access with insertion of the sheath and completion of the intervention without a crossover to conventional femoral access. The primary safety end point was the in-hospital plus 30-day incidence of radial artery occlusion. Secondary end points included intraoperative complications and neurologic complications at discharge and in the following 30 days.

Results: Seventy-one patients with a cerebral aneurysm underwent 73 embolization procedures at our institution. The first-choice access route was the radial artery in 62 patients (87.3%) and the femoral artery in 9 (12.6%). Thirty-four embolizations were performed using coils, 22 used a balloon-assisted coil technique, 6 used a stent-assisted coil technique, and 2 used a flow diverter. Crossover to femoral access was observed in 2 patients (3.1%). Four patients developed coil-induced thrombi requiring intra-arterial tirofiban injections. In 1 case, an aneurysm ruptured during the operation but did not have a clinical impact. No cases of radial artery occlusion or hand ischemia were observed.

Conclusions: A transition to radial access for cerebral aneurysm embolization is feasible and does not increase the level of risk associated with the procedure.

Fig 1.

A middle-aged patient presenting with a ruptured bilobed aneurysm of the anterior communicating artery (measuring 6.8 × 4.8 mm), treated using balloon-assisted coiling via TRA. A, The right ICA was catheterized with a guide catheter via right TRA. B, An angiogram of the right ICA highlights the anterior communicating artery aneurysm. C, An angiogram of the right ICA, with a dual-lumen balloon and microcatheter in place. D, An angiogram of the right ICA shows the total occlusion of the aneurysm.

Fig 2.

A middle-aged patient presenting with a ruptured aneurysm of the anterior communicating artery (measuring 7 × 4 mm), treated using coiling via left TRA. A, The right common carotid artery was catheterized using a Simmons shaped catheter via left TRA; then, a guiding catheter (B) was advanced over it. C, An angiogram of the right ICA highlights the irregular aneurysm of the anterior communicating artery. D, An angiogram of the right ICA shows the total occlusion of the aneurysm.