Article Text

Download PDFPDF

Transarterial and transvenous access for neurointerventional surgery: report of the SNIS Standards and Guidelines Committee


The purpose of this publication is to provide a comprehensive review on the techniques and tools used for vascular access in neurointerventional procedures. Using published literature, we reviewed data on access methods, sites, tools, and techniques for neurointerventions. Recommendations are provided based on quality of data/levels of evidence and, where appropriate, expert consensus. While tools and techniques continue to be developed, current literature and experience supports certain principles regarding vascular access for neurointerventional procedures.

  • Angiography
  • Standards
  • Stroke
View Full Text

Statistics from


  • Twitter @Starke_neurosurgery

  • RMS and BS contributed equally.

  • Collaborators On Behalf of the Society of NeuroInterventional Surgery: SA Ansari, AS Arthur, M Bain, B Baxter, KR Bulsara, M Chen, R De Leacy, K Fargen, D Frei, S Hetts, MS Hussain, MV Jayaraman, P Kan, Y Kayan, RP Klucznik, WJ Mack, T Leslie-Mazwi, RA McTaggart, JM Milburn, PM Meyers, M Mokin, J Mocco, AT Patsalides, CJ Prestigiacomo, GL Pride Jr, AS Puri, AT Rai, C Schirmer, AH Siddiqui and G Toth.

  • Contributors RMS, BS, FAM, CDG, and S-KL were the primary authors and, as such, were responsible for overseeing construction of the document outline, gathering of evidence, and drafting of the manuscript. GD acted as a representative of the Board of the Society of NeuroInterventional Surgery, and provided commentary and editing on behalf of the Board and of the Society as a whole. JFF, as senior author, was responsible for organizing the writing group, overseeing the outline construction, facilitating communication between the writing group and the Standards and Guidelines Committee, drafting and editing of the manuscript, and the submission/proofing for publication.

  • Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. It is funded solely from internal resources of the Society of NeuroInterventional Surgery.

  • Disclaimer This literature review (“Review”) is provided for informational and educational purposes only. Adherence to any recommendations included in this Review will not ensure successful treatment in every situation. Furthermore, the recommendations contained in this Review should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition. This Review and its conclusions and recommendations reflect the best available information at the time the Review was prepared. The results of future studies may require revisions to the recommendations in this Review to reflect new data. SNIS does not warrant the accuracy or completeness of the Review and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this Review or for any errors or omissions.

  • Competing interests JFF is an equity interest holder for Cerelux, and for Fawkes Biotechnology, LLC, and a consultant for Stream Biomedical, Penumbra, and Medtronic Neurovascular. He has research support from the University of Kentucky and the American Heart Association. RMS receives research support from NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, NIH, Miami Clinical and Translational Science Institute, National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. He is a consultant for Penumbra, Abbott, Medtronic, and Cerenovus. GD is a consultant for Medtronic, Microvention, Penumbra, and Cerenovus. He is a shareholder in InNeuroCo, RIST, Cleerly, and eLum. BS has equity in RIST Neurovascular. Dr Kan is a consultant for Stryker and Medtronic Neurovascular. YK is a consultant for Penumbra and for Medtronic Neurovascular. PMM is a consultant for Stryker, Medtronic, Penumbra, and Siemens. ASA is a consultant for Balt, Johnson and Johnson, Leica, Medtronic, Microvention, Penumbra, Scientia, Siemens, and Stryker. He has research support from Cerenovus, Microvention, Penumbra and Siemens. He is a shareholder in Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad Medical, and Vascular Simulations. BB is a consultant for Penumbra, Medtronic, Stryker, Metactive, and 880 Medical, He has stock in Penumbra, and stock options in He has ownership interest in Route 92 and Marblehead. MC is a consultant for Medtronic, Stryker, Genentech, Imperative Health, Microvention, and Cerenovus. RDL is a consultant for Imperative Care, Siemens, and Penumbra, and owns equity in Q’Apel. He is also on the scientific advisory boards for Cerenovus and receives research support from Asahi and Medtronic. KF is a consultant for Cerebrotech. DF is a consultant for Genentech, Penumbra, and Stryker. He has stock ownership in Penumbra. SH has a Royalty Agreement with Penumbra. He Contracts for Core Imaging Lab for Stryker and MicroVention. He has a research contract with Siemens. He is on Data Safety and Monitoring Boards for DAWN, ARISE2, and PHIL trials. He has grant support through NCI and NIBIB. MSH is a consultant for Cerenovus. MVJ is a speaker for Medtronic. RPK is a consultant for Medtronic, Cerenovus, and Microvention. WJM is a consultant for Q’Apel, Rebound Therapeutics, Viseon TSP, Medtronic, Penumbra, and Stream Biomedical. He is an investor in Cerebrotech, Endostream, Viseon, and Rebound Therapeutics.JMM is a consultant for Stryker and Penumbra. MM is a consultant for Canon Medical and Medtronic. He has financial interest in Serenity Medical and VICIS. JM receives research support from Stryker, Penumbra, Medtronic, and Microvention. He is a consultant for Imperative Care, Cerebrotech, Viseon, Endostream, Rebound Therapeutics, and Vastrax. He is an investor/shareholder in BlinkTBI, Serenity, NTI, Neurvana, and Cardinal Consulting. GLP is a consultant for Sequent and Microvention-Terumo. He is on the Data Safety and Monitoring Board for Web-IT Study (Cerenovus) and for the Pulserider NAPA trial. ATR is a consultant for Stryker Neurovascular and Microventions. He is on an Advisory Board for Cerenovus, and is a stockholder in NTI. CS has equity in Neurotechnology Investors. AHS receives research support from NIH. He has financial interests in Amnis Therapeutics, BlinkTBI, Buffalo Technology Partners, Cardinal Consultants, Cerebrotech Medical Systems, Cognition Medical, Endostream Medical, Imperative Care, International Medical Distribution Partners, Neurovascular Diagnostics, Q’Apel Medical, Rebound Therapeutics, Rist Neurovascular, Serenity Medical, Silk Road Medical, Spinnaker Medical, StimMed, Synchron, Three Rivers Medical, and Viseon Spine. He is a consultant for Amnis Therapeutics, Boston Scientific, Canon Medical Systems, Cerebrotech Medical Systems, Cerenovus, Corindus, Endostream Medical, Guidepoint Global Consulting, Imperative Care, Integra, Medtronic, MicroVention, Northwest University, Penumbra, Q’Apel Medical, Silk Road Medical, StimMed, Stryker, Three Rivers Medical, VasSol, and WL Gore and Associates. Dr Toth is a consultant for Dynamed EBSCO.

  • Patient consent for publication Not required.

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

  • Data availability statement There are no independent data in this work.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.