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E-095 Serial dilation technique for ulnar artery access in neuro-endovascular procedures: technical report and systematic review of the literature
  1. M Brandel,
  2. A Wali,
  3. C McCann,
  4. B Tucker,
  5. S Olson,
  6. J Steinberg,
  7. D Santiago-Dieppa,
  8. A Khalessi,
  9. J Pannell
  1. Neurosurgery, UCSD, La Jolla, CA, USA


Background For rare neuro-endovascular cases in which transfemoral access is not feasible and the palmar circulation is insufficient for radial artery access, ulnar artery access may be considered.

Materials and Methods Prior to catheterization, nitroglycerine paste was applied along the distribution of the right ulnar artery. Heparin and verapamil were administered to the ulnar artery via the microdilator. Subsequent serial dilation to 7-French was performed. The 7-French radialsheath was advanced into the ulnar artery over the Nitrex wire. A diagnostic angiogram was performed using a 4-French 120 cm angled glide diagnostic catheter. The sheath was exchanged for a Neuron MAX 88 guide catheter, and a triaxial system consisting of an ACE 60 Penumbra reperfusion catheter, a 3MAX Penumbra reperfusion catheter, and Synchro2 standard wire was inserted. A three-pass mechanical thrombectomy involving aspiration and stent-retriever techniques yielded at TICI 3 result.

Results 67-year-old male developed left MCA syndrome in the setting of an infected abdominal aortic endograft. A transfemoral approach was ruled out due to concern for crossing the infected endograft. Allen test and ultrasound demonstrated that the right radial artery was of adequate size for access, but the ulnar artery was insufficient to support the palmar arch. Mechanical thrombectomy via ulnar artery access was performed to preserve the dominant radial artery. Systematic review of the literature yielded 2 case series of transulnar neurovascular procedures. Access site complications were rare and included 3 access site hematomas and 1 ulnar artery occlusion.

Conclusion We report our technique of serial dilation of the ulnar artery for neuroendovascular procedures and provide a systematic review of the literature for complication avoidance in ulnar artery access.

Abstract E-095 Table 1

Literature review of ulnar artery access for endovascular neuro-intervention

Abstract E-095 Figure 1

A) Ulnar artery angiogram demonstrates normal-caliber radial artery (black arrow) with small caliber ulnar artery (white arrow). B) Left internal carotid artery angiogram demonstrates left M1 segment middle cerebral artery occlusion. C) Left common carotid artery angiogram demonstrates recanalization of left M1 segment after thrombectomy. D) Ulnar artery angiogram demonstrates occlusion of the ulnar artery (white arrow) in the forearm with normal caliber radial artery (black arrow)

Disclosures M. Brandel: None. A. Wali: None. C. McCann: None. B. Tucker: None. S. Olson: None. J. Steinberg: None. D. Santiago-Dieppa: None. A. Khalessi: None. J. Pannell: None.

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