• World Neurosurg · Oct 2020

    Feasibility and Safety of Radial-First Approach with a Radial-Specific Neurointerventional Guiding Sheath for Intracranial Aneurysm Coiling in the Anterior Circulation.

    • Yoshiki Hanaoka, Jun-Ichi Koyama, Toshihiro Ogiwara, Yu Fujii, Kiyoshi Ito, and Tetsuyoshi Horiuchi.
    • Department of Neurosurgery, Shinshu University School of Medicine, Matsumot, Japan. Electronic address: hanaoka@shinshu-u.ac.jp.
    • World Neurosurg. 2020 Oct 1; 142: e297-e306.

    BackgroundIn cardiac intervention, the transradial approach (TRA) is increasingly used as the first-line approach owing to numerous advantages over the transfemoral approach. Neurointerventional TRA, especially in intracranial interventions, is predominantly restricted to an alternative approach, as transradial carotid cannulation using a conventional transfemoral system can be technically challenging for patients with unfavorable acute takeoff of the target common carotid artery. This study evaluated the feasibility and safety of first-line TRA with a radial-specific neurointerventional guiding sheath for a large series of consecutive intracranial anterior circulation aneurysm embolizations.MethodsWe retrospectively analyzed our institutional database of first-line TRA for consecutive coil embolizations of anterior circulation aneurysms conducted between June 2018 and March 2020. A radial-specific 6-F Simmons guiding sheath (0.088-inch inner diameter) was engaged into the target common carotid artery, and subsequently a triaxial or quadraxial system was created for the embolization procedure. We assessed procedural success and procedure-related or vascular access site complications.ResultsA total of 119 patients with intracranial anterior circulation aneurysms underwent 121 coil embolization procedures. Of these, 101 patients who underwent 103 (85.1%) embolization procedures treated with first-line TRA were included. After the triaxial or quadraxial system was constructed, the embolization procedure was successful for all 103 cases without catheter kinking, system instability, or complications.ConclusionsA transradial 0.088-inch triaxial or quadraxial system provided sufficient stability and kink resistance for intracranial aneurysm embolization. This method is feasible, highly successful, and safe for intracranial anterior circulation aneurysm embolization.Copyright © 2020 Elsevier Inc. All rights reserved.

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