Predicting difficult transradial approach guiding into left internal carotid artery on unruptured intracranial aneurysms

Michiyasu Fuga; Toshihide Tanaka; Rintaro Tachi; Kyoichi Tomoto; Ryoto Wachi; Akihiko Teshigawara; Toshihiro Ishibashi; Yuzuru Hasegawa; Yuichi Murayama

doi:10.25259/SNI_355_2023

Predicting difficult transradial approach guiding into left internal carotid artery on unruptured intracranial aneurysms

Surg Neurol Int. 2023 Jul 7:14:233. doi: 10.25259/SNI_355_2023. eCollection 2023.

Authors

Michiyasu Fuga¹, Toshihide Tanaka¹, Rintaro Tachi¹, Kyoichi Tomoto¹, Ryoto Wachi¹, Akihiko Teshigawara¹, Toshihiro Ishibashi², Yuzuru Hasegawa¹, Yuichi Murayama²

Affiliations

¹ Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan.
² Department of Neurosurgery, Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.

Abstract

Background: The transradial approach (TRA) is less invasive than the transfemoral approach (TFA), but the higher conversion rate represents a drawback. Among target vessels, the left internal carotid artery (ICA) is particularly difficult to deliver the guiding catheter to through TRA. The purpose of this study was thus to explore anatomical and clinical features objectively predictive of the difficulty of delivering a guiding catheter into the left ICA via TRA.

Methods: Among 78 consecutive patients who underwent coil embolization for unruptured intracranial aneurysms through TRA in a single institution between March 1, 2021, and August 31, 2022, all 29 patients (37%) who underwent delivery of the guiding catheter into the left ICA were retrospectively analyzed. Clinical and anatomical features were analyzed to assess correlations with difficulty in guiding the catheter into the left ICA.

Results: Of the 29 aneurysms requiring guidance of a catheter into the left ICA, 9 aneurysms (31%) required conversion from TRA to TFA. More acute innominate-left common carotid artery (CCA) angle (P < 0.001) and older age (P = 0.015) were associated with a higher conversion rate to TFA. Receiver operating characteristic analysis revealed that optimal cutoff values for the innominate-left CCA angle and age to distinguish between nonconversion and conversion to TFA were 16° (area under the curve [AUC], 0.93; 95% confidence interval [CI], 0.83-1.00) and 74 years (AUC, 0.79; 95% CI, 0.61-0.96), respectively.

Conclusion: A more acute innominate-left CCA angle and older age appear associated with difficulty delivering the guiding catheter into the left ICA for neurointervention through TRA.

Keywords: Anatomical feature; Conversion; Crossover; Innominate artery; Transradial access.