Transradial approach for neuroendovascular surgery of intracranial vascular lesions

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Object. The authors present their experience in performing a transradial approach for neuroendovascular surgery of intracranial vascular lesions when a transfemoral approach was unfavorable.

Methods. Eight patients ranging in age from 52 to 88 years underwent a total of nine neuroendovascular procedures for intracranial vascular lesions. A transradial approach was used in all patients. The patients had previously undergone a transfemoral approach for the endovascular intervention, but that procedure was unsuccessful. Five patients had intracranial basilar artery (BA) aneurysms, one patient had symptomatic BA stenosis, one patient had a dural arteriovenous fistula in the posterior fossa, and one patient had a high-flow arteriovenous malformation in the frontal lobe.

In each case, a transradial approach achieved a stable platform that allowed intracranial microcatheterization for neuroendovascular intervention. None of the patients experienced complications attributed to the transradial artery approach.

Conclusions. During neuroendovascular surgery for the treatment of intracranial lesions, the transradial approach is a viable alternative if the transfemoral approach is unfavorable. This series represents the first known description of neuroendovascular surgery for intracranial lesions via a transradial approach.

Article Information

Address reprint requests to: Robert A. Mericle, M.D., Department of Neurological Surgery, Box 100265, Gainesville, Florida 32610–0265. email: mericle@neurosurgery.ufl.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Subtracted retrograde angiograms. Left: Angiogram revealing the upper extremity from the wrist to the antecubital fossa after a No. 5 French catheter had been introduced into the RA. Note the presence of vasospasm. Right: Angiogram obtained after a No. 6 French sheath (7.5 French outer diameter) had been introduced into the RA. The vasodilator mixture had also been infused. Note the improved flow and the reduction in vasospasm.

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    Digital subtracted angiogram demonstrating a No. 6 French guiding catheter, which had been placed at the origin of the right VA. Note the retrograde radial-brachial-axillary-subclavian approach.

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