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	<title>flow diverters &#8211; AJNR Blog</title>
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		<title>Anatomic Snuffbox (Distal Radial Artery) and Radial Artery Access for Treatment of Intracranial Aneurysms with FDA-Approved Flow Diverters</title>
		<link>https://www.ajnrblog.org/2021/04/10/anatomic-snuffbox-distal-radial-artery-and-radial-artery-access-for-treatment-of-intracranial-aneurysms-with-fda-approved-flow-diverters/</link>
		
		<dc:creator><![CDATA[jross]]></dc:creator>
		<pubDate>Sat, 10 Apr 2021 17:00:00 +0000</pubDate>
				<category><![CDATA[Fellows' Journal Club]]></category>
		<category><![CDATA[Interventional]]></category>
		<category><![CDATA[flow diverters]]></category>
		<category><![CDATA[intracranial aneurysm]]></category>
		<category><![CDATA[radial artery]]></category>
		<guid isPermaLink="false">https://www.ajnrblog.org/?p=19465</guid>

					<description><![CDATA[Fellows&#8217; Journal Club Flow diverters can be successfully placed via the transradial approach with high technical success, low access site complications, and a low femoral crossover rate. Abstract BACKGROUND AND PURPOSE Transradial access for neurointerventional procedures has been proved a]]></description>
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<h1>Fellows&#8217; Journal Club</h1>
<p>Flow diverters can be successfully placed via the transradial approach with high technical success, low access site complications, and a low femoral crossover rate.</p>
<p class="signature"><img decoding="async" src="http://www.ajnrblog.org/wp-content/uploads/ross-signature.png" alt="" /></p>
<p><span id="more-19465"></span></p>
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<h2 class="signature">Abstract</h2>
<div id="sec-1" class="subsection">
<figure id="attachment_19468" aria-describedby="caption-attachment-19468" style="width: 300px" class="wp-caption alignright"><a href="https://www.ajnrblog.org/wp-content/uploads/F1.large-32.jpg"><img decoding="async" class="wp-image-19468 size-medium" src="https://www.ajnrblog.org/wp-content/uploads/F1.large-32-300x103.jpg" alt="Figure 1 from Kühn et al" width="300" height="103" srcset="https://www.ajnrblog.org/wp-content/uploads/F1.large-32-300x103.jpg 300w, https://www.ajnrblog.org/wp-content/uploads/F1.large-32-630x216.jpg 630w, https://www.ajnrblog.org/wp-content/uploads/F1.large-32-150x51.jpg 150w, https://www.ajnrblog.org/wp-content/uploads/F1.large-32-1536x526.jpg 1536w, https://www.ajnrblog.org/wp-content/uploads/F1.large-32.jpg 1800w" sizes="(max-width: 300px) 100vw, 300px" /></a><figcaption id="caption-attachment-19468" class="wp-caption-text">Frontal roadmap images show a curved origin of the right CCA at the junction of the innominate artery and right subclavian artery origin (<em>arrows</em>, <em>A</em> and <em>B</em>). This anatomy offers a “shelf” for right transradial catheters, which provides good stability, even with a tortuous course of the right CCA (<em>A</em>). Frontal roadmap image demonstrates a straight origin of the left CCA from the aortic arch (<em>C, arrow</em>), which allows good navigation of a right transradial catheter. The transverse portion of the aortic arch may act as a shelf for transradial catheters during intervention, providing good stability for an intervention. Frontal roadmap image shows a bovine-type aortic arch with horizontal origin of the left CCA (<em>D, arrow</em>). Access of the left CCA would be easy from a right transradial approach because the catheter can easily move across midline and into the vessel. There would be no risk of catheter herniation.</figcaption></figure>
<h3 id="p-3">BACKGROUND AND PURPOSE</h3>
<p>Transradial access for neurointerventional procedures has been proved a safer and more comfortable alternative to femoral artery access. We present our experience with transradial (distal radial/anatomic snuffbox and radial artery) access for treatment of intracranial aneurysms using all 3 FDA-approved flow diverters.</p>
<div id="sec-2" class="subsection">
<h3 id="p-4">MATERIALS AND METHODS</h3>
<p>This was a high-volume, dual-center, retrospective analysis of each institution’s data base between June 2018 and June 2020 and a collection of all patients treated with flow diversion via transradial access. Patient demographic information and procedural and radiographic data were obtained.</p>
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<div id="sec-3" class="subsection">
<h3 id="p-5">RESULTS</h3>
<p>Seventy-four patients were identified (64 female patients) with a mean age of 57.5 years with a total of 86 aneurysms. Most aneurysms were located in the anterior circulation (93%) and within the intracranial ICA (67.4%). The mean aneurysm size was 5.5 mm. Flow diverters placed included the Pipeline Embolization Device (Flex) (PED, <em>n</em> = 65), the Surpass Streamline Flow Diverter (<em>n</em> = 8), and the Flow-Redirection Endoluminal Device (FRED, <em>n</em> = 1). Transradial access was successful in all cases, but femoral crossover was required in 3 cases (4.1%) due to tortuous anatomy and inadequate support of the catheters in 2 cases and an inability to navigate to the target vessel in a patient with an aberrant right subclavian artery. All 71 other interventions were successfully performed via the transradial approach (95.9%). No access site complications were encountered. Asymptomatic radial artery occlusion was encountered in 1 case (3.7%).</p>
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<div id="sec-4" class="subsection">
<h3 id="p-6">CONCLUSIONS</h3>
<p>Flow diverters can be successfully placed via the transradial approach with high technical success, low access site complications, and a low femoral crossover rate.</p>
<p><strong data-rich-text-format-boundary="true">Read this article: <a href="https://bit.ly/39Y0OA9">https://bit.ly/39Y0OA9</a></strong></p>
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