{"id":19465,"date":"2021-04-10T12:00:00","date_gmt":"2021-04-10T17:00:00","guid":{"rendered":"https:\/\/www.ajnrblog.org\/?p=19465"},"modified":"2021-04-09T14:43:23","modified_gmt":"2021-04-09T19:43:23","slug":"anatomic-snuffbox-distal-radial-artery-and-radial-artery-access-for-treatment-of-intracranial-aneurysms-with-fda-approved-flow-diverters","status":"publish","type":"post","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\/","title":{"rendered":"Anatomic Snuffbox (Distal Radial Artery) and Radial Artery Access for Treatment of Intracranial Aneurysms with FDA-Approved Flow Diverters"},"content":{"rendered":"<div class=\"editor-comment\">\n<h1>Fellows&#8217; Journal Club<\/h1>\n<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>\n<p class=\"signature\"><img decoding=\"async\" src=\"http:\/\/www.ajnrblog.org\/wp-content\/uploads\/ross-signature.png\" alt=\"\" \/><\/p>\n<p><!--more--><\/p>\n<\/div>\n<h2 class=\"signature\">Abstract<\/h2>\n<div id=\"sec-1\" class=\"subsection\">\n<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 loading=\"lazy\" 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 K\u00fchn 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=\"auto, (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 \u201cshelf\u201d 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>\n<h3 id=\"p-3\">BACKGROUND AND PURPOSE<\/h3>\n<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>\n<div id=\"sec-2\" class=\"subsection\">\n<h3 id=\"p-4\">MATERIALS AND METHODS<\/h3>\n<p>This was a high-volume, dual-center, retrospective analysis of each institution\u2019s 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>\n<\/div>\n<div id=\"sec-3\" class=\"subsection\">\n<h3 id=\"p-5\">RESULTS<\/h3>\n<p>Seventy-four patients were identified (64 female patients) with a mean age of 57.5\u2009years 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\u2009mm. Flow diverters placed included the Pipeline Embolization Device (Flex) (PED,\u00a0<em>n<\/em>\u00a0= 65), the Surpass Streamline Flow Diverter (<em>n<\/em>\u00a0= 8), and the Flow-Redirection Endoluminal Device (FRED,\u00a0<em>n<\/em>\u00a0= 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>\n<\/div>\n<div id=\"sec-4\" class=\"subsection\">\n<h3 id=\"p-6\">CONCLUSIONS<\/h3>\n<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>\n<p><strong data-rich-text-format-boundary=\"true\">Read this article: <a href=\"https:\/\/bit.ly\/39Y0OA9\">https:\/\/bit.ly\/39Y0OA9<\/a><\/strong><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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.<\/p>\n","protected":false},"author":21,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,9],"tags":[1626,494,1625],"class_list":["post-19465","post","type-post","status-publish","format-standard","hentry","category-fellows-journal-club","category-interventional","tag-flow-diverters","tag-intracranial-aneurysm","tag-radial-artery"],"_links":{"self":[{"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/posts\/19465","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/comments?post=19465"}],"version-history":[{"count":2,"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/posts\/19465\/revisions"}],"predecessor-version":[{"id":19470,"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/posts\/19465\/revisions\/19470"}],"wp:attachment":[{"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/media?parent=19465"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/categories?post=19465"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ajnrblog.org\/wp-json\/wp\/v2\/tags?post=19465"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}