Transradial approach using a distal access catheter without guiding support for symptomatic intracranial vertebral artery and basilar artery stenosis: a multicenter experience and technical procedure

2021 ◽  
pp. neurintsurg-2021-017635
Author(s):  
Xu Guo ◽  
Lifeng Wang ◽  
Jialin Liu ◽  
Lei Yu ◽  
Yudong Ma ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Artery Stenosis ◽  
Patient Comfort ◽  
Technical Success ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Randomized Controlled ◽  
Technical Procedure ◽  
Basilar Artery Stenosis

BackgroundThere is little consensus on endovascular treatment for symptomatic intracranial posterior circulation stenosis via the transradial approach (TRA). We report our multicenter experience and technical procedures that directly used a distal access catheter (DAC) via TRA for the treatment of symptomatic intracranial vertebral (VA) and basilar (BA) artery stenosis.MethodsFrom January 2019 to December 2020, 92 consecutive patients with severe symptomatic intracranial VA or BA stenosis were retrospectively collected and divided into two groups (TRA group and transfemoral approach (TFA) group) for neurointerventional treatment. The percentages of catheters reaching the V3/V4 segment of the VA and technical success, postoperative care conditions, preoperative outcomes and complications, long term clinical outcomes, and imaging follow-ups were observed.ResultsThe catheter, CAT 5, reached the V4 segment of the VA in 37 TRA patients (88.1%). The duration of the procedure was significantly shorter in the TRA group than in the TFA group (median 48.0 min vs 55.5 min, p=0.037). More patients in the TRA group could walk within 2 hours after the procedure (85.7% vs 10.0%, p=0.000), and the duration of retaining catheterization in the TRA group was shorter (3.0±1.2 hours vs 11.7±5.6 hours, p=0.000).ConclusionThis study demonstrates the potential feasibility and safety of using a DAC via the TRA without guiding support for the treatment of symptomatic intracranial VA and BA stenosis. The TRA demonstrated some advantages over the standard TFA in terms of patient comfort. Further randomized controlled trials comparing the TRA and TFA for posterior circulation stenosis are needed.

scholarly journals Acute Symptomatic Basilar Artery Stenosis: MR Imaging Predictors of Early Neurologic Deterioration and Long-term Outcomes

Radiology ◽  
2016 ◽  
Vol 280 (1) ◽  
pp. 193-201 ◽  
Author(s):  
Woo-Jin Lee ◽  
Keun-Hwa Jung ◽  
Young Jin Ryu ◽  
Keon-Joo Lee ◽  
Soon-Tae Lee ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Basilar Artery ◽  
Artery Stenosis ◽  
Long Term Outcomes ◽  
Neurologic Deterioration ◽  
Basilar Artery Stenosis

scholarly journals Medium- and Long-Term Effects of Endovascular Treatments for Severely Stenotic Basilar Arteries Supported by Multimodal Imaging

2020 ◽  
Author(s):  
Yuanzhi Li ◽  
Weimin Xie ◽  
Xianghao Gong ◽  
Dongliang He ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Neurological Dysfunction ◽  
Long Term Effects ◽  
Technical Success ◽  
Technical Success Rate ◽  
Atherosclerotic Stenosis ◽  
Stenosis Rate ◽  
Basilar Artery Stenosis

Abstract Background: To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging.Method: After strict screening of 67 patients with symptomatic severe basilar artery stenosis (70%- 99%) with atherosclerotic stenosis, 67 patients with symptomatic recurrence after intensive drug treatment were treated with intravascular balloon dilatation and Enterprise stent implantation. Any stroke or death within 30 days after operation and any stroke and restenosis during medium-and long-term follow-up were followed up.Results: The mean age of 67 patients(67lesions) was 57 ± 8 years old, and the technical success rate was 100%; ②Preoperative angiography showed that the collateral circulation was poor, and TICI was 1-2a while postoperative angiography showed that TICI was significantly improved to 2b-3; ③The average preoperative stenosis rate was 82 ± 9%, and the postoperative stenosis rate was reduced to 17 ± 10%; ④Before surgery, abnormal perfusion was found in the posterior circulation CTP; After the postoperative re-examination, the posterior circulation of CTP perfusion was significantly improved; ⑤Postoperative symptoms and neurological conditions improved significantly; ⑥Complications of perforating branch event occurred in 1 case after operation, and symptoms were relieved after more than 1 month of active treatment, and mild neurological dysfunction remained. 1 case developed subacute thrombosis in the stent, which improved after active intra-arterial thrombolysis, and there was no residual neurological dysfunction; and 1 case of microlead wire being clamped by the distal vasospasm. ⑦67 patients were followed up by telephone, WeChat or imaging for 36–66 months. 55 cases were regularly reviewed with images. Intrastenting stenosis occurred in 4 cases, and 12 cases were followed up by phone or WeChat.The average follow-up period was 56 ± 21 months (36–66 months). No TIA or stroke occurred during follow-up.Conclusions: In summary intravascular balloon dilation + Enterprise stent implantation is safe and effective for the treatment of symptomatic severe atherosclerotic stenosis of the basilar artery, with high technical success rate, low perioperative complications, and good mid-term and long-term effects.

Stenting of the Extracranial Carotid Artery in a High-Risk Population

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 31-36 ◽  
Author(s):  
K. Matsushita ◽  
F. Akai ◽  
Y. Teramoto ◽  
Y. Yokoi ◽  
A. Aoki ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Stenting ◽  
High Risk Population ◽  
Technical Success ◽  
Transfemoral Approach ◽  
Extracranial Carotid Artery ◽  
Risk Patients ◽  
Potential Benefits ◽  
The Mean

The results of nine patients with carotid stenosis in a high-risk surgical population that were treated by stent supported angioplasty are reported. There were eight males and one female between the ages of 53 to 74. A balloon expandable stent was deployed by a transfemoral approach. Technical success was achieved in all cases. There were no periprocedural complications. The mean % stenosis decreased from 84% to 5.2% after stenting. No arterial dissection was recorded and smooth contour of the vessel was demonstrated in all patients. We have observed long term patency for over 6 months in seven patients. Mean angiographic stenosis was 20% and 21% at 3 and 6 months, respectively (range, 5 to 32%). No further stenosis was recorded. Carotid stenting is an alternative strategy to carotid endoarterectomy (CEA) for high-risk patients, for whom the complications of CEA may exceed the potential benefits.

scholarly journals Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography

2019 ◽  
Vol 11 (7) ◽  
pp. 710-713 ◽  
Author(s):  
Marie-Christine Brunet ◽  
Stephanie H Chen ◽  
Samir Sur ◽  
David J McCarthy ◽  
Brian Snelling ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Hospital Costs ◽  
Artery Occlusion ◽  
Patient Comfort ◽  
Complication Rates ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Access Site Complication ◽  
Patient Demographics

BackgroundThe transradial approach for endovascular angiography and interventional procedures is superior to the traditional transfemoral approach in several metrics, including lower access-site complication rates, higher patient satisfaction, and lower hospital costs. Interventional cardiologists have begun to adopt the distal transradial approach (dTRA) for coronary interventions as it has an improved safety profile and improved procedural ergonomics. Adaptation of dTRA for neuroendovascular procedures promises similar benefit, but requires a learning curve.ObjectiveTo report the first use of dTRA for diagnostic cerebral angiography and demonstrate the feasibility and safety of a dTRA.MethodsA retrospective review of our prospective institutional database of consecutive cases of cerebral DSA performed via dTRA between August 2018 and December 2018 was performed. Patient demographics, procedural and radiographic metrics, and clinical data were recorded.Results85 patients were identified with an average age of 53.8 years (range 18–82); 67 (78.8%) patients were female. 78 patients underwent successful dTRA diagnostic cerebral angiography, with a mean of five vessels catheterized and average fluoroscopy time of 12.0 min, or 2.6 min for each vessel. Seven patients required conversion to transfemoral access, with the most common reason being inability to advance the wire and radial artery spasm. There were no complications.ConclusiondTRA is associated with decreased rates of radial artery occlusion, ischemic hand events, as well as improved patient comfort, faster periprocedural management, and cost benefits. Our preliminary experience with dTRA for diagnostic cerebral angiography demonstrates excellent feasibility and safety in combination with relative efficiency.

scholarly journals Wingspan stenting can effectively prevent long-term strokes for patients with severe symptomatic atherosclerotic basilar stenosis

2016 ◽  
Vol 22 (3) ◽  
pp. 318-324 ◽  
Author(s):  
Wei-Xing Bai ◽  
Bu-Lang Gao ◽  
Tian-Xiao Li ◽  
Zi-Liang Wang ◽  
Dong-Yang Cai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Basilar Artery ◽  
Demographic Data ◽  
Artery Stenosis ◽  
Stroke Rate ◽  
Technical Success Rate ◽  
Basilar Artery Stenosis ◽  
Procedural Complications ◽  
Ischemic Attack

Objective To investigate the safety and long-term effect of using the Wingspan stent for severe symptomatic atherosclerotic basilar artery stenosis (≥70%). Materials and methods Between July 2007 and April 2013, we had 91 consecutive patients (age range 41–82 years old) with symptomatic severe basilar stenosis (70–99%) who underwent Wingspan stenting at our center. All patients had stenosis-related temporary ischemic attack or strokes. We analyzed the demographic data, pre- and post-procedural cerebral angiography, technical success rate, peri-procedural complications, and clinical and imaging follow-ups. Results The Wingspan stenting procedure was successful in all patients: The stenosis was reduced from 82.2% ± 5.8% pre-stenting to 15.9% ± 5.7% post-stenting. The 30-day peri-operative rate for stroke or death was 14.3%, which included ischemic stroke in 12 cases (12/91 = 13.2%) and subarachnoid hemorrhage in one case (1/91 = 1.1%), with a fatal or disabling stroke rate of 2.2%. Among the 77 patients with clinical follow-up assessment within 7–60 months (mean 31.3 ± 15.1 months) after stenting, four patients (5.2%) had posterior ischemia, including one patient with disabling ischemic stroke (1.3%) and three patients (3.9%) with temporary ischemic attack. The 2-year cumulative stroke rate was 16% (95% CI: 8.2–23.8%). Among 46 patients with imaging assessments at 3–45 months (mean, 9.5 ± 8.3) post-stenting, six (13.0%) patients had restenosis, including two (2/46 = 4.3%) with symptomatic restenosis. Conclusions The benefit of stenting for patients with severe basilar artery stenosis (> 70%) may lie in lowering the long-term fatal and disabling stroke rate; and as long as the peri-operative stroke rate can be kept at a relatively lower level, patients with severe basilar stenosis can benefit from basilar artery stenting.

scholarly journals Simultaneous Stenting for Symptomatic Tandem Extracranial and Intracranial Posterior Circulation Stenoses: Long-Term Outcomes and Procedural Experience

2021 ◽  
Vol 12 ◽  
Author(s):  
Zichang Jia ◽  
Yanqing Zhao ◽  
Peng Wang ◽  
Jintao Han ◽  
Shilu Zhao ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Posterior Circulation ◽  
Technical Success ◽  
Long Term Outcomes ◽  
Technical Success Rate ◽  
Stent Restenosis

Few studies have reported on simultaneous endovascular stenting for tandem posterior circulation (PC) stenoses and its long-term outcomes. Thus, our aim was to investigate the safety and efficacy of simultaneous stenting in patients with symptomatic tandem extra- and intracranial PC stenoses. From September 2014 to June 2018, 16 such patients with symptomatic stenoses who underwent simultaneous stent placement were analyzed. The primary outcome was occurrence of any stroke, TIA, or death within 30 days after the procedure. The secondary outcomes were technical success, clinical success, and the occurrence of in-stent restenosis ≥50% during follow-up. Technical success was defined as stent coverage of all tandem lesions and residual stenosis <30%. Clinical success was determined based on any occurrence of neurological events or death within 3 months after the procedure. All stents (19 intracranial and 14 extracranial) were placed with a technical success rate of 100%. One patient experienced a pontine ischemic stroke 2 days after the procedure and had recovered well at discharge. One patient experienced a minor complication of groin hematoma. The clinical success rate was 93.75% (15/16). During a median follow-up of 36.0 ± 11.0 months, two patients developed ISR ≥50% at the 1-year follow-up. None of the patients experienced stroke, TIA, or death after discharge during follow-up. Simultaneous stenting for symptomatic tandem extra- and intracranial PC stenoses is safe and feasible. Its impact on long-term stroke prevention is promising, and further study of a larger patient population is needed.

Long-term outcome of endovascular stenting for symptomatic basilar artery stenosis

Neurology ◽  
2005 ◽  
Vol 65 (8) ◽  
pp. 1340-1341 ◽  
Author(s):  
O. O. Zaidat ◽  
T. P. Smith ◽  
M. J. Alexander ◽  
W. Yu ◽  
W.S. Smith ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Artery Stenosis ◽  
Endovascular Stenting ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Basilar Artery Stenosis

Safety and Feasibility of Transradial Access in Patients Presenting With Traumatic Injuries: A Single Urban Center Experience

2020 ◽  
Vol 54 (8) ◽  
pp. 665-669
Author(s):  
Aesha Patel ◽  
Antony Sare ◽  
Muhammad U. Shahid ◽  
Abhishek Kumar ◽  
Pratik A. Shukla
Keyword(s):  
External Iliac Artery ◽  
Trauma Team ◽  
Covered Stent ◽  
Radiology Department ◽  
Endovascular Management ◽  
Technical Success ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Technical Success Rate ◽  
Traumatic Bleeding

Purpose: To evaluate the efficacy, safety, and feasibility of transradial approach (TRA) for endovascular management of traumatic bleeding. Materials and Methods: A retrospective review was performed at a single level 1 trauma institution from August 2018 to July 2019. Patients presented to the interventional radiology department who were intended to be treating using TRA for the management of trauma-induced bleeding were selected. Demographics, indication for embolization, embolization site, preprocedural labs, hemodynamic stability, technical success, and complications were recorded. Results: Transradial approach was attempted in 29 (74.4%) of the 39 patients identified by operators who prefer TRA. Four patients received treatment using TRA on 2 separate occasions, for a total of 33 procedures completed with a technical success of 97% (32/33). Transradial approach was safely completed in 9 patients (27.3%) with preprocedural hemodynamically unstable status. For the 10 patients who received treatment via a transfemoral approach (TFA), traumatic disfiguration of the left upper extremity, preexisting arterial lines placed by the trauma team, and external iliac artery injuries requiring covered stent placement were the most common indications for TFA over TRA. There were no procedural or access site–related complications. Conclusion: Transradial approach for the endovascular management of bleeding in a trauma setting is safe and effective with a high technical success rate and no complications.

Long-term outcome of endovascular stenting for symptomatic basilar artery stenosis

Neurology ◽  
2005 ◽  
Vol 64 (6) ◽  
pp. 1055-1057 ◽  
Author(s):  
W. Yu ◽  
W. S. Smith ◽  
V. Singh ◽  
N. U. Ko ◽  
S. P. Cullen ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Artery Stenosis ◽  
Endovascular Stenting ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Basilar Artery Stenosis
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