Abstract WP24: Utility of the Sheath Guide Specifically Designed for Transbrachial Approach in Endovascular Treatment of Neurovascular Diseases

Abstract

Background and purpose: Transfemoral approach has been a common technique in endovascular treatment (ET) of neurovascular diseases. When aortic or peripheral arterial conditions limit transfemoral approach, transbrachial approach is attempted as the alternative. The purpose of our study was to report the utility of novel sheath guide specifically designed for transbrachial approach in ET for carotid or cerebral vascular pathology. Methods: Included in our analysis were patients who underwent transbrachial ET with the sheath guide for transbrachial approach between 2011 and 2014. The sheath guide has a 6Fr (2.24 mm, 0.088 inch) internal diameter (ID) with 90 cm in length, a soft distal part and a particular distal shape like a modified Simmons catheter. The MSK-guide 7.5 has 7.5 cm of the distal part in length for the common carotid artery and the MSK-guide 15 has 15.0 cm of the distal part in length for the internal carotid artery. Carotid artery stenting and external carotid artery embolization were performed with the MSK-guide 7.5, and ET for intracranial lesions with MSK-guide 15. Results: Two hundred and seventy patients underwent transbrachial ET with the particular sheath guide. The procedures included treatment of 143 extracranial carotid stenosis, 31 intracranial carotid stenosis, 50 intracranial aneurysms, 25 AVMs/DAVFs and 21 acute ischemic strokes. Transbrachial carotid cannulation was easy and successful in every case except for one case (0.4%) with brachial artery spasm. After transbrachial carotid cannulation of MSK-guide, procedures were performed easily through the sheath guide in every case. On sheath-related periprocedural complications, 2 pseudoaneurysms (0.7%) and brachial artery occlusions (0.7%) occurred after ET or a follow-up period, respectively. Conclusion: The sheath guide specifically designed for transbrachial approach provided a favorable impact upon ET of neurovascular diseases.