E-082\u2005Initial experience with transradial access for neurointerventions: Feasibility and safety of next generation .088” intracranial guide catheters

Abstract

Background Several reports have demonstrated significant clinical benefits with transradial access compared to transfemoral access for endovascular procedures. Despite this, the transradial technique for neurointerventions is underutilized due to the anatomical complexities that may affect a successful procedure using conventional access catheter technology. The purpose of this single-center study was to evaluate the feasibility and safety of next generation large-bore intracranial guide catheters (0.088” inner diameter, 8Fr) using a transradial approach (TRA) in carefully selected patients undergoing neurointerventions. Methods The retrospective review of the institutional, IRB-approved database was undertaken to find cases where the TracStar LDP™ or Zoom™ 88 guide catheters (Imperative Care, Campbell, CA) were used with a TRA for neurointerventions. For this study, gender, age, case type, target anatomy, distal location reached with the guide catheters, time from access to reperfusion, complications, and the Thrombolysis in Cerebral Infarction (TICI) score were collected. Safe placement of the guide catheters to the target anatomy was considered a technical success. Results From August 2020 to March 2021, 13 patients underwent TRA neurointerventions using the TracStar LDP or Zoom 88 guide catheters. The TracStar LDP was used in 77% (10/13) of patients; the Zoom 88 guide catheter was used in 23% (3/13) of patients. The type of intervention was acute ischemic stroke in 69% (9/13) of patients and aneurysm embolization in 31% (4/13) of patients. The TracStar LDP facilitated the implantation of flow diverters in all aneurysm cases with 75% (3/4) using a biaxial system. Overall, there was an even distribution between females (54%, 7/13) and males (46%, 6/13). The median age was 72.5 (range=48-88) years. Most patients with aneurysms were females (75%, 3/4); this population’s median age was 58.5 (range=54-64) years. In patients with acute ischemic stroke, the median age was 76 (range=48-88) years. The target anatomy for all aneurysm patients was the left internal carotid artery. The target anatomy for stroke patients included right internal carotid artery in 77.8% (7/9) of patients, left internal carotid artery in 11.1% (1/9) of patients and left vertebral artery in 11.1% (1/9) of patients. In these patients, the final positions of the guide catheters included Supraclinoid Carotid (n=2), Ophthalmic segment (n=2), Petrous Carotid, Petro-Cavernous junction, Basilar, Cavernous-Carotid, and in one case the Zoom 88 was positioned in the right M1. The median puncture to reperfusion time was 30.5 (range=5-50) minutes. The TICI 2b or greater was achieved in 77.8% (7/9) of patients. There were no complications associated with the guide catheters. In two patients (one stroke, one aneurysm), the TracStar LDP guide catheter was used successfully as the rescue option after the initial approach with the 0.079” radial guide catheter failed. Conclusion Transradial access with the TracStar LDP and Zoom 88 large-bore guide catheters is feasible and safe in achieving intracranial access for neurointerventions in carefully selected patients. Disclosures L. Lyons: None. M. Abouelleil: None. A. Restrepo Orozco: None. L. Verhey: None. J. Tsai: 2; C; Cerenovus, Medtronic. P. Mazaris: 2; C; Stryker. J. Singer: 2; C; Medtronic, Cerenovus, Stryker, Pneumbra, Nico.