Introduction/Purpose Two factors limiting first line radial access for complex cerebrovascular interventions include: radial artery diameter and available catheter technology. Our rule for patient selection is to maintain a radial artery/sheath ratio of ≥.8, which we used as the primary inclusion criteria for all procedures. We have increasingly attempted sheathless radial access allowing for largest inner and smallest outer diameter. We describe a low cost/simplified approach to direct radial access with a commonly available guide catheter. We then present our experience of transradial cerebrovascular interventions comparing outcomes between procedures performed using a 6F Terumo Slender Sheath/Benchmark guide (OD 2.53 mm) versus direct sheathless radial access with the Benchmark (OD 2.0 mm).
Materials and Method Single institution retrospective electronic query of all 6F radial access procedures performed between October 2010 and March 2020 access for cerebrovascular intervention using a Penumbra Benchmark 6F guiding catheter. The procedures were divided in Group 1 - 133 pts (sheath) and Group 2- 32 patients (sheathless). Summary Technique for Direct/Sheathless Access
1. Ultrasound guided: Target vessel selection/measurement. *Inclusion: artery diameter/sheath diameter ≥.8 )
4 F micropuncture/21 g needle: Radial angiogram and Radial cocktail Exchange: Micropuncture sheath/sheathless Benchmark/BER over .035 × 180 cm glidewirePrimary outcomes included: failure of primary access (need to convert to femoral access) and major complications requiring surgery or transfusion. Secondary outcomes included: infection, development of AV fistula, or development of pseudoaneurysm.
Results Procedural success (completion of planned procedure) was achieved in 98.2% of patients (average of groups 1 and 2), no significant difference. Procedures performed included a wide spectrum of intracranial pathologies, however, aneurysm treatment represented >60% of procedures. Success with the primary access site cannulation was 100% for both Group 1 and Group 2, when using rule of ≥ .8. No major complications were encountered in either group of patients; no patients required transfusion or emergency vascular surgery for vessel injury/avulsion, digital ischemia, or compartment syndrome. One patient was identified in Group 1 with a symptomatic radial artery-vein fistula underwent successful elective out-patient surgical repair at 12 months.
Conclusion Sheathless radial access using a Penumbra Benchmark 071 guiding catheter can be used for cerebrovascular interventions in both anterior and posterior circulation pathology. High technical success completing index procedure, success with arterial cannulation and low complication rates may be attributed to patient selection/technique (maintaining artery/sheath ratio of ≥ .8). Direct radial access requires smaller vessel diameter potentially expanding eligible patients with smaller radial artery diameters.
Disclosures S. Satti: None. T. Eden: None.
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