ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2019 October;63(5):509-17

DOI: 10.23736/S0390-5616.19.04761-1

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Transradial approach for the treatment of brain aneurysms using flow diversion: feasibility, safety, and outcomes

Ahmad SWEID ¹, Robert M. STARKE ², Nabeel HERIAL ¹, Nohra CHALOUHI ¹, Vivian XU ¹, Kavya SHIVASHANKAR ¹, Lohit VELAGAPUDI ¹, Stavropoula TJOUMAKARIS ¹, Michael R. GOOCH ¹, David HASAN ³, Hekmat ZARZOUR ¹, Robert H. ROSENWASSER ¹, Pascal JABBOUR ¹ ✉

¹ Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA; ² Department of Neurosurgery, University of Miami Hospital, Miami, FL, USA; ³ Department of Neurosurgery, University of Iowa, Iowa City, IA, USA

BACKGROUND: The aim of this paper is to describe our experience with the transradial approach (TRA) for intracranial aneurysms treatment using the Pipeline Embolization device (PED). We also performed a logistic regression comparing outcomes between TR and transfemoral approach (TFA).
METHODS: The clinical and imaging characteristics as well as periprocedural outcomes of patients treated for aneurysms using a TRA with PED were analyzed retrospectively.
RESULTS: A total of 598 aneurysms were treated with pipeline during a period extending from 2010-2019 (N.=580 [97%] using TFA vs. N.=18 [3%] using TRA). About 84.28% (N.=504) were females, and the average age was 55.5 years. There was no significant difference between both approaches in procedural duration, complication rate, morbidity, and aneurysms obliteration. We did not encounter any access site complication in the TR group compared to 2% in the TF; however, this did not reach statistical significance. One case was converted to TFA due to the need for more support. Multivariate analysis did not show that the access site was an independent predictor of the complications, morbidity, and aneurysms obliteration.
CONCLUSIONS: The results of this study illustrate that the transradial approach is a safe and effective means of treating intracranial aneurysms with PED. The TRA in selected patients offers better safety with high rates of procedural success.

KEY WORDS: Radial artery; Therapeutic embolization; Catheterization; Femoral artery