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. 2025 Jun 5;17(6):e85432.
doi: 10.7759/cureus.85432. eCollection 2025 Jun.

Initial Experience in Assessing the Stability of the Rist Guide Catheter for Transradial Neurointerventions

Yuki Kozaki  1 , Kenji Fukuda  1 , Syota Sakai  2 , Kodai Matsuda  1 , Fumiaki Fujihara  1 , Tooru Inoue  1 , Hiroshi Abe  3
Affiliations

Initial Experience in Assessing the Stability of the Rist Guide Catheter for Transradial Neurointerventions

Yuki Kozaki et al. Cureus. .

Abstract

Introduction: The Rist guide catheter is specifically designed for transradial neurointervention (TRN) and has demonstrated efficacy in accessing distal intracranial vessels, achieving a high success rate. We investigated the impact of catheter position on its stability during TRN.

Materials and methods: This retrospective study included 17 patients who underwent neuroendovascular procedures using the 7-French Rist guide catheter from March 2024 to February 2025. The procedures involved intracranial aneurysm and middle meningeal artery embolization. Catheter stability was evaluated based on its position and the effective catheter length (ECL), which is defined as the distance from the origin of the target vessel to the catheter tip.

Results: Stable catheter positioning was achieved in 13 out of 17 cases at the petrous segment of the internal carotid artery (ICA), the V3/4 segment of the vertebral artery (VA), and the distal external carotid artery (ECA) segment. The petrous segment corresponded to an ECL of approximately 20 cm, while the V3/4 or distal ECA segments corresponded to 16 cm. One case required switching to femoral access, but the procedure was successful in all cases, with no access site complications observed.

Conclusion: Our initial experience demonstrated that the position of the Rist catheter was relevant to its stability during TRN. Understanding its behavior would improve preprocedural planning and contribute to successful outcomes.

Keywords: cerebral aneurysm surgery; chronic subdural hematoma (csdh); rist guide catheter; transradial approach; transradial neurointervention.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Method for estimating the effective catheter length
Method for estimating the effective catheter length (ECL) using anteroposterior (AP) (left) and lateral (right) angiographic views. The catheter trajectory is divided by key turning points (a–d / b'–d') along the catheter’s path from the origin of the target vessel (arrowhead) to the catheter tip (arrow). Dashed lines connect these points to reflect the length of each segment of the catheter route. To estimate the total ECL, lengths between these points were measured in both AP and lateral views, and the longer value for each segment was adopted to compensate for vessel curvature and projection differences. In this case, the ECL was calculated as a + b′ + c + d′, selecting the longer measurement from either the AP or lateral view at each segment.
Figure 2
Figure 2. Cases with stable Rist catheter positioning
(A) Angiogram showing the right internal carotid artery (ICA) paraclinoid segment aneurysm treated using a stent-assisted technique. The Rist catheter (arrow) was positioned at the petrous segment of the ICA, which corresponds to an effective catheter length (ECL) of approximately 20 cm from the origin of the common carotid artery (arrowhead). (B) Angiogram showing the basilar artery aneurysm treated using a balloon-assisted technique. The Rist catheter (arrow) was positioned at the V4 segment of the right vertebral artery, which corresponds to an ECL of approximately 16 cm from the origin of the vertebral artery (arrowhead). (C) Angiogram showing a middle meningeal artery embolization for a left chronic subdural hematoma. The Rist catheter (black arrow) was positioned at the distal segment of the external carotid artery, which corresponds to an ECL of approximately 17 cm from the origin of the common carotid artery (arrowhead).
Figure 3
Figure 3. Cases with unstable Rist catheter positioning
(A) Angiogram showing a right internal carotid artery (ICA) paraclinoid segment aneurysm, treated with a flow diverter. It reveals a relatively straight segment from the origin of the common carotid artery (black arrowhead) to the cervical ICA, lacking any significant vessel curvature. (B) A spasm was identified at the petrous segment of the ICA (black arrow). (C) The Rist catheter (black arrow) was retracted to the cervical segment (corresponding to an effective catheter length (ECL) of 16cm). The procedure was successfully performed due to the support of a 5F distal access catheter (DAC) (white arrow). (D) Angiogram showing a middle meningeal artery embolization for a left chronic subdural hematoma. The Rist catheter (black arrow) slid downwards to the common carotid artery, which corresponds to an ECL of 10 cm. The procedure was successfully performed due to the support of 3.2F DAC (white arrow).
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