Feasibility and Challenges of Transradial Approach in Neuroendovascular Therapy: A Retrospective Observational Study

• Published in: Journal of Neuroendovascular Therapy 2024, Vol.18(1), pp.10-17
• Main Authors: Tanoue, Shunsuke, Ono, Kenichiro, Toyooka, Terushige, Nakagawa, Masaya, Wada, Kojiro
• Format: Article
• Language: English
• Subjects: case series; neuroendovascular therapy; Original; radial access
• ISSN: 1882-4072; 2186-2494
• DOI: 10.5797/jnet.oa.2023-0048

Objective: Transradial approach (TRA) is increasingly used as a viable alternative to the traditional transfemoral approach (TFA) in neuroendovascular therapy (NET) owing to its potential anatomical benefits and lower puncture-site complication rates. However, the real-world challenges of implementing TRA-NET have not been thoroughly studied, particularly those related to guide catheter (GC) placement. In this study, we aimed to explore the feasibility and challenges of TRA-NET, with a specific focus on GC placement.Methods: This retrospective observational study included patients who underwent NET at our institution between December 2019 and May 2022. Procedural success was defined as the successful placement of a GC in the target vessel. Cases in which a Simmons-shaped GC was used or the approach was changed to TFA were classified as difficult. Safety was assessed based on the rate of severe puncture-site complications requiring either blood transfusion or surgical intervention.Results: Among the 310 patients who underwent NET during the study period, 222 (71.6%) with a median age of 74 years were selected for TRA-NET. The target vessel was in the left anterior circulation (LtAC) in 101 (45.5%) patients, and 8-F GCs were the most frequently used (40.1%). TRA-NET achieved a 95.0% success rate, with a switch to TFA required in 5.0% of the cases. Procedural challenges occurred in 42 (18.9%) patients, primarily in those with LtAC lesions. Specifically, a type III aortic arch (p