Bilateral Transradial Access for Complex Posterior Circulation Interventions

Evan Luther, David McCarthy, Michael Silva, Ahmed Nada, Allison Strickland, Stephanie Chen, Joshua Burks, Samir Sur, Dileep Yavagal, Eric Peterson, Robert M. Starke

Research output: Contribution to journalArticle

Abstract

Background: Transradial access (TRA) has recently gained traction as the preferred approach in a variety of neurointerventions after studies have demonstrated equivalent outcomes with fewer complications than transfemoral access (TFA). However, multiple access sites are occasionally necessary when simultaneous selective catheterization of 2 vessels is required. We present the first cases detailing bilateral TRA for complex posterior circulation interventions. Case Descriptions: All neuroendovascular cases in which bilateral TRA was obtained at the University of Miami/Jackson Health System were reviewed. Two patients, each with complex left vertebral artery aneurysms, were identified. In each case, bilateral TRA was chosen because 1) left vertebral artery catheterization via right TRA can be technically challenging; 2) simultaneous catheterization of both vertebral arteries was felt to be necessary; 3) prior angiograms had demonstrated that the subclavian arteries would provide the most direct, anatomically feasible access route; and 4) the primary surgeon preferred to avoid TFA. Right TRA and left distal transradial access via the anatomic snuffbox were obtained in both cases to allow both arms to sit on the operator side of the table. Neither patient experienced any perioperative complications. Conclusions: Bilateral TRA can be an effective method for catheterizing both vertebral arteries during complex posterior circulation interventions and obviates the need for TFA when multiple arterial access sites are required. Furthermore, distal transradial access allows the left hand to remain more anatomically neutral while being positioned on the right side of the table so that both access sites remain ergonomically favorable for the interventionalist.

Original languageEnglish (US)
Pages (from-to)101-105
Number of pages5
JournalWorld neurosurgery
Volume139
DOIs
StatePublished - Jul 2020

Keywords

  • Aneurysm
  • Aneurysm embolization
  • Bilateral transradial access
  • Neuroendovascular
  • Posterior circulation
  • Subarachnoid hemorrhage
  • Transradial access

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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  • Cite this

    Luther, E., McCarthy, D., Silva, M., Nada, A., Strickland, A., Chen, S., Burks, J., Sur, S., Yavagal, D., Peterson, E., & Starke, R. M. (2020). Bilateral Transradial Access for Complex Posterior Circulation Interventions. World neurosurgery, 139, 101-105. https://doi.org/10.1016/j.wneu.2020.03.221