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Hemorrhagic Stroke
Original research
Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study
  1. Stephanie H Chen1,
  2. Brian M Snelling2,
  3. Sumedh Subodh Shah1,
  4. Samir Sur1,
  5. Marie Christine Brunet1,
  6. Robert M Starke1,3,
  7. Dileep R Yavagal1,4,
  8. Joshua W Osbun5,
  9. Eric C Peterson1
  1. 1 Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  2. 2 Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, Florida, USA
  3. 3 Department of Radiology, University of Miami School of Medicine, Miami, Florida, USA
  4. 4 Department of Neurology, University of Miami, Miami, Florida, USA
  5. 5 Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
  1. Correspondence to Dr Eric C Peterson, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL 33136, USA; ericpete{at}med.miami.edu

Abstract

Background The transradial approach (TRA) to endovascular procedures decreases access site morbidity and mortality in comparison with the traditional transfemoral technique (TFA). Despite its improved safety profile, there is a concern that TRA is less favorable for neurointerventional procedures that require large coaxial systems to manage the small tortuous cerebral vessels.

Objective To report our experience with TRA for flow diverter placement for treatment of unruptured cerebral aneurysms.

Methods We performed a retrospective review of prospective institutional databases at two high-volume centers to identify 49 patients who underwent flow diversion for aneurysm treatment via primary TRA between November 2016 and November 2018. Patient demographics, procedural techniques, and clinical data were recorded.

Results Of the 49 patients, 39 underwent successful flow diversion placement by TRA. Ten patients were converted to TFA after attempted TRA. There were no procedural complications. Reasons for failure included tortuosity in eight patients and severe radial artery spasm in two.

Conclusions In the largest reported series to date of flow diverter deployment via TRA for aneurysm treatment, we demonstrate the technical feasibility and safety of the method. The most common reason for failure of TRA was an acute angle of left common carotid artery origin or left internal carotid artery tortuosity. Overall, our data suggest that increasing adoption of TRA is merited given its apparent equivalence to the current TFA technique and its documented reduction in access site complications.

  • aneurysm
  • flow diverter
  • intervention
  • technique

https://doi.org/10.1136/neurintsurg-2018-014620

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    Footnotes

    • Contributors All authors contributed to the conception, data gathering, and drafting of the manuscript. DRY, RMS, and ECP provided manuscript oversight and administrative support. All authors critically reviewed the manuscript and approved its final submission.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests BMS is a stockholder in RIST Neurovascular. RMS is a consultant for Medtronic Neurovascular, Cerenovus, and Abbott. DRY is a consultant for Medtronic Neurovascular, Cerenovus, and Rapid Medical and Neural Analytics. JWO is a consultant for Microvention. ECP is a consultant for Stryker Neurovascular, Penumbra, Medtronic Neurovascular, and Cerenovus, and is a stockholder in RIST Neurovascular.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.