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. 2021 Feb;27(1):68-74.
doi: 10.1177/1591019920938961. Epub 2020 Jul 5.

Transradial access for flow diversion of intracranial aneurysms: Case series

Muhammad Waqas  1   2 , Kunal Vakharia  1   2 , Rimal H Dossani  1   2 , Gary B Rajah  1   2 , Michael K Tso  1   2 , Andrew D Gong  1   2 , Kyungduk Rho  3 , Hamid H Rai  3 , Kenneth V Snyder  1   2   4   5   6 , Elad I Levy  1   2   5   6 , Adnan H Siddiqui  1   2   5   6 , Jason M Davies  1   2   5   6   7
Affiliations

Transradial access for flow diversion of intracranial aneurysms: Case series

Muhammad Waqas et al. Interv Neuroradiol. 2021 Feb.

Abstract

Background: Transradial access for neurointerventions offers advantages of fewer access-site complications, reduced procedure time, and greater patient comfort over transfemoral access. Data about transradial access for flow diversion are limited. We share our early experience with transradial access for flow diversion in a relatively large case series.

Methods: Consecutive patients who underwent Pipeline embolization device (Medtronic) deployment via transradial access were included in the study, irrespective of location and laterality of the intracranial aneurysm. The cases were performed between July 2016 and October 2019. Demographics, aneurysm characteristics, and procedure-related details (including catheter systems used) were recorded and statistically evaluated.

Results: Thirty-five transradial flow diversion procedures were attempted in 32 patients, of which 33 procedures were successful. In two cases involving left common carotid artery and internal carotid artery access, guide catheter herniation into the aortic arch led to abandonment of transradial access in favor of transfemoral access. The most common aneurysm locations in the transradial access procedures were the posterior communicating artery (n = 7), ophthalmic artery (n = 7), and superior hypophyseal artery (n = 7). Most transradial access procedures (66.7%) were performed using a biaxial catheter system. 6-French Benchmark (Penumbra) and Phenom 27 (Medtronic) were the most commonly utilized guide- and microcatheters, respectively. One patient had intraprocedural subarachnoid hemorrhage. No access-site complications occurred.

Conclusion: This study demonstrates safety and feasibility of transradial access for Pipeline embolization device deployment and shows the versatility of this approach for different catheter systems. Tortuosity and acute angulation of the left common carotid artery and internal carotid artery were associated with approach failure.

Keywords: Transradial intervention; benchmark guide catheter; flow diversion; intracranial aneurysm; pipeline embolization device.

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Conflict of interest statement

Declaration of conflicting interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Snyder: Consulting and teaching for Canon Medical Systems Corporation, Penumbra Inc., Medtronic, and Jacobs Institute. Co-Founder: Neurovascular Diagnostics, Inc. Levy: Shareholder/Ownership interests: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care (formerly the Stroke Project), Rebound Therapeutics, StimMed, Three Rivers Medical; National Principal Investigator/Steering Committees: Medtronic (merged with Covidien Neurovascular) SWIFT Prime and SWIFT Direct Trials; Honoraria: Medtronic (training and lectures); Consultant: Claret Medical, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, Rebound, StimMed; Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical, Endostream Medical; Site Principal Investigator: CONFIDENCE study (MicroVention), STRATIS Study—Sub I (Medtronic). Siddiqui: Financial interest/investor/stock options/ownership: Adona Medical, Inc, Amnis Therapeutics (Purchased by Boston Scientific October 2017), Blink TBI Inc., Buffalo Technology Partners Inc., Cerebrotech Medical Systems, Inc., Cognition Medical, Endostream Medical Ltd., Imperative Care, International Medical Distribution Partners, Neurovascular Diagnostics Inc., Q’Apel Medical Inc, Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular Inc., Sense Diagnostics, Inc., Serenity Medical Inc., Silk Road Medical, Spinnaker Medical, Inc., StimMed, Synchron, Three Rivers Medical Inc., Vastrax, LLC, VICIS, Inc., Viseon Inc; Consultant/advisory board: Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc., Cerebrotech Medical Systems Inc., Cerenovus, Corindus Inc., Endostream Medical Ltd., Imperative Care, Inc. Integra LifeSciences Corp., Medtronic, MicroVention, Minnetronix Neuro, Inc., Northwest University–DSMB Chair for HEAT Trial, Penumbra, Q’Apel Medical Inc., Rapid Medical, Rebound Therapeutics Corp.(Purchased by Integra LifeSciences Corp.), Serenity Medical Inc., Silk Road Medical, StimMed, Stryker, Three Rivers Medical, Inc., VasSol, W.L. Gore & Associates; Principal investigator/steering comment of the following trials: Cerenovus NAPA and ARISE II; Medtronic SWIFT PRIME and SWIFT DIRECT; MicroVention FRED & CONFIDENCE; MUSC POSITIVE; and Penumbra 3D Separator, COMPASS, INVEST, TIGER. Davies: Research grant: National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001413 to the University at Buffalo. Consulting: Medtronic; Honoraria: Neurotrauma Science, LLC; shareholder/ownership interests: RIST Neurovascular, Cerebrotech. The remaining authors have no potential conflicts of interests to disclose.

Figures

Figure 1.
Figure 1.
The use of a biaxial system. Angiographic run of the right radial artery showing normal anatomy (a). Lateral (b) and anteroposterior (c) projections of left ICA injection showing a superior hypophyseal artery aneurysm (arrow). Deployment of a PED (Medtronic, Dublin, Ireland) across the neck of the aneurysm (d). A Phenom 27 microcatheter (Medtronic) (small black arrow) and a Benchmark guide catheter (Penumbra, Alameda, CA) (large white arrow) constitute the biaxial system in this case. Complete deployment of the PED on lateral projection (e), followed by a final run, anteroposterior projection (f).
Figure 2.
Figure 2.
The use of a triaxial system. Modified Seldinger technique was used to place a sheathless 4F Fubuki guide catheter (Asahi Intecc, Aichi, Japan) for a transradial approach. An angiographic run of the right radial artery was obtained to ensure proper placement of the catheter (a). CCA run demonstrates severe tortuosity of the ICA (arrows) (b). An ICA injection shows a fusiform ICA aneurysm near the ICA bifurcation on anteroposterior (c) and lateral (d) projections (arrows). A PED (Medtronic, Dublin, Ireland) is delivered across the aneurysm neck (arrows) (e). Post-PED deployment run, anteroposterior projection (arrow) (f).
See this image and copyright information in PMC

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