• World Neurosurg · Apr 2022

    Anatomical factors that impede using the radial artery approach for carotid artery revascularization.

    • Takeshi Uno, Masaaki Shojima, Yuta Oyama, Fumitaka Yamane, Masahiro Shin, and Akira Matsuno.
    • Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan; Department of Neurosurgery, Yaentoge Neurosurgical Hospital, Tokyo, Japan. Electronic address: unot-tky@umin.ac.jp.
    • World Neurosurg. 2022 Apr 1; 160: e398-e403.

    ObjectivesWe investigated the anatomical characteristics that complicate utilizing the radial artery approach (RAA) for craniocervical intravascular intervention.MethodsThe data of 73 lesions in 65 consecutive patients who underwent transradial cervical carotid artery intervention was evaluated. We assessed the success rate of RAA in right-sided and left-sided lesions. The diameters and angles of the left and right common carotid arteries and the aortic, brachiocephalic, and right subclavian arteries, which constitute the paths of the guiding sheath, were assessed for each of the left- and right-sided lesions.ResultsIt was difficult to apply RAA in 10 cases (13.7%), of which 2 (5.0%) involved right-sided and 8 (24.2%) left-sided lesions. The approach was significantly more difficult to perform in left-sided than in right-sided lesions (P = 0.02). Although the treatments were successfully completed, crossover to the femoral artery approach was required in 4 cases (5.5%, 2 cases for left-sided lesions). Placement of the guiding sheath in the common carotid artery was successful for all right-sided lesions; however, the guiding sheath slipped off to the aorta during stent advancement in 2 cases. When the angle between the brachiocephalic artery and aortic arch was small, the introduction of the guiding sheath to left-sided lesions was difficult in eight cases (P = 0.0001).ConclusionsRAA was difficult to perform in cases involving left-sided lesions and a small angle between the brachiocephalic artery and aortic arch. This study could help delineate the factors associated with difficulty of catheter introduction and instability of RAA.Copyright © 2022 Elsevier Inc. All rights reserved.

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