Prohibitive Radial Artery Occlusion Rates Following Transradial Access Using a6-French Neuron MAX Long Sheath for Intracranial Aneurysm Treatment.

Abstract

To evaluate the feasibility, safety, and rate of radial artery occlusion (RAO) after the treatment of intracranial aneurysms using a6F Neuron MAX (Penumbra, Alameda, CA, USA) long sheath directly into the radial artery. All consecutive patients treated for unruptured intracranial aneurysms with TRA using a6F Neuron MAX catheter between September 2019 and May 2021 in asingle tertiary center were screened. They were referred to aconsultation and an ultrasound-Doppler assessment of the radial artery 3months after treatment with the attending neuroradiologist. Patients with available assessment of the radial artery patency were included. A total of 17patients (median age: 58years, range35-68 years; sex ratio F/M: 15/2) were treated for intracranial aneurysms using a6F Neuron MAX directly into the right radial artery and included. Treatment was atechnical success for 16/17 (94%) patients and 1 patient (6%) required aconversion to femoral access. The median radial artery diameter at the puncture site was 2.7 mm (range 1.8-2.9mm). No symptomatic RAO was noted during follow-up. Assessment at 3months revealed 7/17 (41%) asymptomatic RAOs. Even if technically feasible, the use of a6F Neuron Max long sheath for triaxial catheterization in intracranial interventions, especially flow diversion, may be responsible for ahigh radial artery occlusion rate (41%). Although being asymptomatic in all cases in our series, this high occlusion rate may be aconcern for further interventions. The development of dedicated radial long sheaths for neurointerventions, with external hydrophilic coating, seems necessary.