Selective use of transradial access for endovascular treatment of severe intracranial vertebrobasilar artery stenosis

Clin Neurol Neurosurg. 2015 Jul;134:116-21. doi: 10.1016/j.clineuro.2015.04.015. Epub 2015 Apr 29.

Abstract

Objective: To study the feasibility and safety of transradial artery access for endovascular intervention of severe intracranial vertebrobasilar stenosis for selected patients not suitable for transfemoral access.

Methods: This was a retrospective analysis of 58 patients who had undergone intervention for severe intracranial vertebrobasilar stenosis using transradial access between January 2012 and September 2014. The reasons for transradial access were traced. The outcome measures were the technical success rate, 30-day stroke or death in the territory of the culprit artery, periprocedural and access site complication rates.

Results: Out of the 58 patients, 19 patients (32.8%) used the transradial approach due to poor iliofemoral artery access, 28 (48.3%) due to unfavorable brachiocephalic or subclavian artery anatomy, 11 (19%) due to unfavorable vertebral artery anatomy. The technical success rate was 100%. There were four periprocedural complications, one of which was asymptomatic. The 30-day stroke rate was 5.2% (3/58 patients), with two of them having no residual neurological deficits. There was no mortality. None had access site complications.

Conclusions: For selected patients with severe intracranial vertebrobasilar stenosis with difficult femoral access or anatomical variations precluding provision of a stable support for intracranial intervention, the transradial approach was shown to be a safe and feasible alternative route of access. Future trials of endovascular treatment for intracranial posterior circulation strokes should take into account the route of access.

Keywords: Angioplasty; Endovascular; Radial artery; Stenosis; Transradial.

Publication types

  • Clinical Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angioplasty / methods*
  • Aorta, Thoracic / abnormalities
  • Aorta, Thoracic / diagnostic imaging
  • Basilar Artery / diagnostic imaging
  • Basilar Artery / surgery*
  • Brachiocephalic Trunk / abnormalities
  • Brachiocephalic Trunk / diagnostic imaging
  • Catheterization, Peripheral / methods
  • Cerebral Angiography
  • Cohort Studies
  • Constriction, Pathologic / therapy
  • Endovascular Procedures / methods
  • Feasibility Studies
  • Femoral Artery / abnormalities
  • Femoral Artery / diagnostic imaging
  • Humans
  • Iliac Artery / abnormalities
  • Iliac Artery / diagnostic imaging
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Postoperative Complications
  • Radial Artery*
  • Retrospective Studies
  • Stents
  • Subclavian Artery / abnormalities
  • Subclavian Artery / diagnostic imaging
  • Treatment Outcome
  • Vertebral Artery / diagnostic imaging
  • Vertebral Artery / surgery*
  • Vertebrobasilar Insufficiency / diagnostic imaging
  • Vertebrobasilar Insufficiency / therapy*

Substances

  • Platelet Aggregation Inhibitors