Details

Autor(en) / Beteiligte

• Koyama, Junichi

Titel

Transradial Approach as the First Line in Anterior Circulation Neurointervention

Ist Teil von

• Neurosurgery, 2020-12, Vol.67 (Supplement_1)

Ort / Verlag

Philadelphia: Wolters Kluwer Health, Inc

Erscheinungsjahr

2020

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• INTRODUCTION In neurointervention, transradial approach (TRA) has been the alternative method chosen only for patients with problems in transfemoral route. In the cardiovascular territory, TRA has already recognized as superior to transfemoral approach. Since 2016, we have attempted TRA as the first line in anterior circulation neurointervention for limited patients already underwent preoperative examination for approach route. METHODS Approach routes, anterior- or posterior lesions, procedures, target vessels, puncture laterality, indwelling techniques, indwelled catheters and complications were analyzed. RESULTS TRA was used in 202 cases, and rates of TRA increased from 11.7% in 2016 to 72.1% in 2019. In anterior circulation lesions, TRA increased from 62.5% in 2016 to 86.6% in 2019. In anterior circulation TRA, carotid stenting was 55.7% and aneurysm coiling was 43.2%. Target vessel was 54% in the right and 46% in the left side. Descending aorta anchoring, Push-in, Pull-back and subclavian artery anchoring techniques were used for indwelling the guiding sheath into common carotid artery. 6-Fr Simmonds-shaped long guiding sheath was used in 99%. Punctured radial artery was 96.2% in the right, and 3.8% in the left side. TRA was failed in only one case (0.5%). No ischemic complication related to placement of the guiding sheath was observed. CONCLUSION With using appropriate indwelling techniques based on preoperative evaluation of approach route, most cases of neurointervention could be treated by TRA regardless of the laterality of the target vessel. TRA could be considered to be the first line method for even in the anterior circulation neurointervention.