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New Devices and Techniques
Left distal radial access in patients with arteria lusoria: insights for cerebral angiography and interventions
  1. Neil Majmundar1,
  2. Pratit Patel1,
  3. Arjun Gadhiya2,
  4. Nitesh Vijay Patel1,
  5. Gaurav Gupta2,
  6. Pankaj K Agarwalla1,
  7. Priyank Khandelwal1
  1. 1 Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  2. 2 Neurological Surgery, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
  1. Correspondence to Dr Priyank Khandelwal, Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; pk544{at}njms.rutgers.edu

Abstract

Background The transradial approach (TRA) is frequently used for neurointerventional procedures as it is safer, improves patient comfort, and decreases costs and procedural time in comparison with the transfemoral approach (TFA). Patients with arteria lusoria, or an aberrant right subclavian artery (ARSA), provide a unique challenge for cerebral angiography and interventions when using the TRA.

Objective To examine the hypothesis that the extreme angulation encountered while accessing the great vessels from the right TRA could be overcome by reversing the approach to the left distal TRA (dTRA).

Methods A prospectively maintained database of transradial neurointerventional cases since 2018 was searched. Six cases from 850 were identified, in which the left dTRA was used. Three cases were for patients with an ARSA. For the three cases of interest, patient history, pathology, imaging, and access techniques were reviewed.

Results Two diagnostic cerebral angiography cases and one intervention were successfully performed through a left dTRA.

Conclusions Proper positioning of the left wrist and familiarity with forming the Simmons catheter can overcome this anatomical challenge. This technique and results further demonstrate that the left distal radial artery is a feasible access site for catheterization of bilateral carotid, left vertebral, and right subclavian arteries for patients with an ARSA.

  • angiography
  • intervention
  • technique

https://doi.org/10.1136/neurintsurg-2020-016199

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    Footnotes

    • Contributors All authors have contributed to this manuscript. NM, AG, and PP drafted and edited the manuscript. The manuscript was edited by, and project was overseen by, PKA, GG, and PK. NVP edited and provided illustration assistance.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval IRB Pro2018002912.

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