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. 2021 Aug;27(4):566-570.
doi: 10.1177/1591019920982812. Epub 2020 Dec 26.

Endovascular management of radial artery loop for neuroangiography: Case series

Rimal H Dossani  1   2 , Muhammad Waqas  1   2 , Michael K Tso  1   2 , Justin M Cappuzzo  1   2 , Daniel Popoola  3 , Kenneth V Snyder  1   2   4   5 , Elad I Levy  1   2   4   5   6 , Adnan H Siddiqui  1   2   4   5   6 , Jason M Davies  1   2   4   5   7
Affiliations

Endovascular management of radial artery loop for neuroangiography: Case series

Rimal H Dossani et al. Interv Neuroradiol. 2021 Aug.

Abstract

Background: Radial loops are rare congenital radial artery anomalies that may pose a significant challenge to successful transradial neuroangiography. In this case series, we describe the anatomy and frequency of radial artery loops and provide a technique for successful navigation of this anatomic anomaly.

Methods: We reviewed our database of radial diagnostic or interventional neuroangiographic procedures to identify cases in which a radial loop was encountered during the procedure. The loop pattern, the presence of an associated recurrent radial artery branch, navigation technique, and procedure-related complications were recorded. A descriptive analysis was performed.

Results: A total of 997 transradial approach procedures were performed over a 9-month period. A radial loop was identified in 10 (1.0%) patients. The average age was 68.6 ± 14.3 years. A microcatheter advanced over a microwire was used to navigate the loop and avoid entry into the recurrent branch. A diagnostic neuroangiographic procedure was performed successfully in 8 cases and an intervention was performed successfully in 1 case. A 360° loop was present in 2 of these cases. In each case, transradial access was performed successfully. In 1 other diagnostic case, transradial access was aborted, and the femoral artery was accessed to perform the procedure.

Conclusions: A radial loop was present in 1% of the cases in this series. Our technical results suggest that this anomaly should not be considered a contraindication to transradial neuroangiography because the procedure was successfully performed in most (9 of 10) cases using a microcatheter system to navigate the loop.

Keywords: Radial artery access; radial artery loop; recurrent radial artery; transradial approach.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RHD, MW, MKT, JMC, DP: None. EIL: 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). AHS: 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 committee for 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. KVS: Consulting and teaching for Canon Medical Systems Corporation, Penumbra Inc., Medtronic, and Jacobs Institute. Co-founder: Neurovascular Diagnostics, Inc. JMD: 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: Cerebrotech, RIST Neurovascular.

Figures

Figure 1.
Figure 1.
Case 6. (a) Right radial artery injection shows a 360° loop of the radial artery. A recurrent branch is seen arising from the apex of the loop (black arrow). Roadmap guidance was used to negotiate the loop using a Synchro2 microwire (Stryker Neurovascular, Fremont, CA) and Headway Duo microcatheter (MicroVention Terumo, Aliso Viejo, CA). (b) Relative straightening of the loop (black arrows) can be seen after a Sim2 Select catheter (Penumbra, Alameda, CA) is passed through the loop. (c) A mild degree of vasospasm was noticed at the conclusion of the procedure (black arrow). It is possible that the spasm was worse while the catheter was in place.
Figure 2.
Figure 2.
Case 3. (a) This is an example of a typical radial loop (black arrow) with a recurrent branch arising from the apex (white arrows). (b) Inadvertent catheterization of the recurrent radial artery led to severe vasospasm (white arrows) of the radial artery and resulted in procedural failure through radial access. The radial artery loop is indicted with a black arrow.
See this image and copyright information in PMC

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