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Technical video
Navigating a proximal loop in the radial artery and avoiding the recurrent radial artery
  1. Rimal Dossani1,2,
  2. Muhammad Waqas1,2,
  3. Michael K Tso1,2,
  4. Gary B Rajah1,2,
  5. David E Smolar1,2,
  6. Jason M Davies1,2,3,4,5
  1. 1 Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
  2. 2 Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
  3. 3 Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
  4. 4 Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
  5. 5 Jacobs Institute, Buffalo, New York, USA
  1. Correspondence to Dr Jason M Davies, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; jdavies{at}ubns.com

Abstract

Several anatomical variations of the radial artery have been described in the literature. Common variations include radial artery loop, recurrent branch, and anastomotic channels connecting the radial and brachial arteries. These variations can pose significant technical challenges to safe radial artery catheterization. Because radial access for neurointervention is becoming popular, appreciation of these variations and mastery of techniques for safe radial artery catheterization are of paramount importance. In this operative video,(video 1) we present a case of a 75-year-old man who underwent middle meningeal artery embolization for treatment of chronic subdural hematoma using a transradial approach. The patient was found to have a radial artery loop and a recurrent branch off the radial artery. The loop could not be negotiated with the conventional technique. We therefore used a microcatheter system with a stiff microwire to navigate and straighten the radial loop under road map guidance. The remaining procedure was performed successfully.

  • catheter
  • guidewire
  • intervention
  • navigation
  • technique

https://doi.org/10.1136/neurintsurg-2019-015712

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    Footnotes

    • Contributors Conception and design: all authors. Acquisition of data: all authors. Analysis and interpretation of data: all authors. Drafting the abstract: MW, DES. Producing the video: RD, MW. Critically revising the submission: all authors. Reviewing the submitted version: all authors.

    • 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 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. Shareholder/ownership interests: RIST Neurovascular, Cerebrotech. The other authors have no competing interests.

    • Patient consent for publication Obtained.

    • Ethics approval The patient gave informed consent for treatment and video recording and publication of the

      abstract and video. Institutional review board approval was deemed unnecessary.

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