Distal Access Catheters for Coaxial Radial Access for Posterior Circulation Interventions

Abstract

The neurointerventional field is moving towards transradial access. Among the favorable indications for TRA is for posterior circulation/vertebrobasilar interventions. For some neurointerventions, a tri-axial system (guide catheter, distal access catheter "DAC", and microcatheter) is typically used for optimal support. We describe application of a new technique in which we forgo use of the guide catheter, using the DAC only for coaxial access via the radial approach and its potential advantages. A retrospective review was performed of our institutional database for cases using our coaxial distal access catheter technique for posterior circulation interventions. Patient characteristics, radiographic, and clinical information were reviewed. All reviews were approved by Institutional Review Board and ethics committee, and all patient identifiers were removed RESULTS: 12 patients were found that met our criteria. Successful access and procedural completion was achieved in 11/12 (92%). Mechanical thrombectomy accounted for 7 cases; two of these patients were also stented via the same approach/technique. Other cases included two successful aneurysm treatments (one flow diverter, one coil embolization), a balloon test occlusion for a cervical chordoma, and an AVM embolization. Trans-radial access with a distal access catheter provides support equivalent to a triaxial system with a coaxial construct in the posterior circulation. This has the advantage of using a smaller system in the radial and vertebrobasilar artery without losing stability. This technique can be used effectively and safely for a variety of posterior circulation neuro endovascular interventions.