Introduction Radial artery access is often the preferred technique for cerebrovascular procedures in the modern era and is increasingly adopted by interventionalists. To date, few dedicated radial access systems for neurointerventional procedures have been developed. Herein, we describe our initial experience with the Armadillo guide catheter (Q’Apel Medical, Fremont, CA, USA), a 7F radial access system with select flex technology specifically designed for cerebrovascular neurointerventional procedures.

Methods We report a single institutional consecutive series of patients treated with the Armadillo guide catheter. Case selection included patients with cerebral aneurysms, dural arteriovenous fistulae, chronic subdural hematomas, and arteriovenous malformations. Data was collected in retrospective fashion in accordance with institutional IRB policies.

Results 57 patients underwent endovascular intervention via radial artery access using the Armadillo guide catheter (Q’Apel Medical, Fremont, CA, USA). The average age was 60.6 years (median 63.0), and 71.9% of patients (n = 41) were female. The majority of patients (79.1%, n = 34) underwent embolization for intracranial aneurysms, 6 patients (10.5%) underwent embolization of dural arteriovenous fistulas (dAVF), 1 patient (n = 1.7%) underwent arteriovenous malformation (AVM) embolization, 1 patient (1.7%) with a chronic subdural hematoma (cSDH) was treated with middle meningeal artery embolization (MMAE), and 1 patient (1.7%) underwent coil sacrifice of the left vertebral artery. Of the 43 patients with aneurysms, 33 (76.7%) were treated with a flow diverter, 6 (13.9%) were treated with a Woven EndoBridge (WEB; Microvention Terumo, Aliso Viejo, CA, USA) device, and 3 (7.0%) underwent stent-assisted coil embolization. In total, 27 Pipeline Embolization Devices (PED; Medtronic Inc, Minneapolis, MN, USA), 5 Flow Re-Direction Endoluminal Devices (FRED; Microvention Terumo, Aliso Viejo, CA, USA), 1 Surpass device (Stryker, Kalamazoo, MI, USA), and 6 WEBs were deployed through the Armadillo radial access system as well as 3 stent-assisted coil embolizations for the treatment of intracranial aneurysms. There were no complications across the 57 patients.

Conclusion Here we present the successful treatment of a wide range of intracranial pathology using the Armadillo radial access system. All cases were successfully completed with favorable procedural safety and clinical outcomes during the follow-up period without access-related morbidity or mortality. To date, this series represents largest cohort describing initial experience with the Armadillo radial access system for cerebrovascular interventions.

Disclosures A. Kappel: None. A. Feroze: None. M. Sukumaran: None. O. Choudhri: 2; C; Microvention, Siemens, Q’apel Medical.