Transradial Approach as the Primary Vascular Access with a 6-Fr Simmons Guiding Sheath for Anterior Circulation Interventions: A Single-Center Case Series of 130 Consecutive Patients

World Neurosurg. 2020 Jun:138:e597-e606. doi: 10.1016/j.wneu.2020.03.003. Epub 2020 Mar 9.


Objective: In coronary intervention, the transradial approach (TRA) is increasingly used as the primary vascular access because of its numerous advantages over the transfemoral approach. However, in neurointerventions, conventional TRA with a straight-shaped guiding system is used as an alternative vascular access because transradial carotid cannulation can be technically challenging for right common carotid artery (CCA) lesions with steep angulation to the right subclavian artery or left CCA lesions with a nonbovine origin. The purpose of the present study was to evaluate the feasibility and safety of TRA as the primary vascular access with a pre-shaped Simmons guiding sheath for anterior circulation interventions.

Methods: Between June 2018 and September 2019, 130 consecutive patients (75 carotid artery stenting and 55 cerebral aneurysm coiling cases) who underwent TRA as the primary vascular access were included in this study. A 6-Fr Simmons guiding sheath was introduced into the target CCA by selecting a cannulation technique based on preprocedural image assessment. We retrospectively analyzed the carotid cannulation success, procedural success, and periprocedural or vascular access site complications.

Results: Carotid cannulation (69 right CCA, 6 left CCA with a bovine origin, and 55 left CCA with a nonbovine origin) and the subsequent procedure were successfully performed for all 130 patients without periprocedural or vascular access site complications.

Conclusions: TRA with a 6-Fr Simmons guiding sheath for anterior circulation interventions is highly successful and safe for all target CCAs and aortic arch types. This method can be utilized as the primary vascular access for anterior circulation interventions.

Keywords: Anterior cerebral circulation; Carotid artery stenting; Cerebral aneurysm coiling; First-line access; Neuroendovascular procedure; Neurointervention; Transradial access.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carotid Artery, Common / anatomy & histology*
  • Carotid Artery, Common / surgery*
  • Carotid Stenosis / surgery
  • Endovascular Procedures / methods
  • Female
  • Humans
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Radial Artery*
  • Retrospective Studies
  • Stents
  • Subclavian Artery / anatomy & histology
  • Treatment Outcome
  • Vascular Access Devices*