Serial dilation to enable ulnar artery access for endovascular neurointervention: Technical report and systematic review of the literature

• Published in: Journal of stroke and cerebrovascular diseases 2024-11, Vol.33 (11), p.107900, Article 107900
• Main Authors: Brandel, Michael G., McCann, Carson P., Tucker, Brigham, Wali, Arvin R., Steinberg, Jeffrey A., Santiago-Dieppa, David R., Khalessi, Alexander A., Pannell, J. Scott
• Format: Article
• Language: English
• Subjects: Endovascular; Femoral artery; Neuro-intervention; Palmar arch; Radial artery; Thrombectomy; Ulnar artery
• ISSN: 1052-3057; 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2024.107900

For rare neuro-endovascular cases in which transfemoral access is not feasible and the palmar circulation is insufficient for radial artery access, ulnar artery access may be considered. Mechanical thrombectomy via ulnar artery access was performed to preserve the dominant radial artery. The ulnar artery was serial dilated to 7-French with microdilator. Angiography was performed using a diagnostic catheter. The sheath was exchanged for a guide catheter, and a triaxial system was inserted. A mechanical thrombectomy was performed. The systematic literature review included all studies pertaining to techniques for ulnar artery access for neurointervention in the last 20 years (2003–2023) published in the PubMed, Web of Science, and Embase databases. 67-year-old male developed left MCA syndrome in the setting of an infected abdominal aortic endograft. A transfemoral approach was ruled out due to concern for crossing the infected endograft. Allen test and ultrasound demonstrated that the right radial artery was of adequate size for access, but the ulnar artery was insufficient to support the palmar arch. Mechanical thrombectomy resulted in TICI 3 reperfusion. Systematic review of the literature yielded 2 case series and 1 case report of transulnar neurovascular procedures. Access site complications were rare and included 3 access site hematomas and 1 ulnar artery occlusion. We report our technique of serial dilation of the ulnar artery for neuroendovascular procedures and provide a systematic review of the literature for complication avoidance in ulnar artery access.