Transradial access of neuro-endovascular interventions with aberrant right subclavian arteries: Case series and literature review

Abstract

IntroductionTransradial artery access (TRA) reduces puncture site complications and is becoming standard in neuro-endovascular procedures. An aberrant right subclavian artery (ARSA) is a congenital anomaly affecting 0.5% to 2% of the population, complicating cerebral angiography via TRA.Case presentationThree cases of neuro-endovascular treatment involving ARSA and TRA are reported. In the first case, ARSA was detected during the induction of a 7Fr RIST from the right distal radial artery (dRA), and treatment continued with transfemoral access. In the second case, ARSA was identified pre-interventionally, and a left dRA approach was selected with a 6Fr Axcelguide Stiff-J with pulling-up methods. The third case involved the successful induction of a 7Fr RIST with some tips to the right internal carotid artery, followed by the placement of a flow diverter.DiscussionARSA, a congenital anomaly, complicates TRA due to its abnormal bifurcation. Cerebral angiography with ARSA is challenging, often requiring alternative access routes. We gathered our 3 reports and the 11 literature reports, with 3 switching to femoral access due to the difficulty of catheter navigation. Two guiding methods in TRA are discussed, with the "pull-back technique" often applied with the Simmonds-type guiding catheter but sometimes ineffective.ConclusionThree neuro-interventional cases with TRA and ARSA are presented, with two successful treatments. The limited cases underscore the need for preoperative access route examination and the development of alternative methods in case of failure. This urgency highlights the importance of ongoing research and innovation in the field.

Keywords: Transradial approach; aberrant right subclavian artery; distal radial artery.

Figure 1.

A plain radiograph of the catheter was guided into the right CCA in case 2. The catheter is guided through the ARSA, reversed near the aorta valve, and then guided into the right CCA. ARSA: aberrant right subclavian artery.

Figure 2.

The illustration shows how the guiding catheter is delivered in case 2. A stiff inner catheter, 6Fr SY6 was guided into the right common carotid artery (a).Then a stiff guide wire was passed through the right external carotid artery, followed the SY6 (b). The Axcelguide Stiff-J was then guided along SY6 into the right common carotid artery. The yellow line is the Axcelguide, the green line is SY6, and the black line is a guidewire.

Figure 3.

The illustration shows how the guiding catheter is delivered in case 3. The SY3 was stabilized at the aortic valve (a), secured the left internal carotid artery, and placed at the carotid artery's orifice with a guidewire (b). The RIST was guided distally to the cervical portion of the left internal carotid artery (c), with distortion in the aorta released with pulling (d). The yellow line is the RIST, the green line is SY3, and the black line is a guidewire.