Simplified Transradial Access for Aneurysms Treatment: A Guiding System Using Solo Distal Access Catheter and Anatomical Considerations

Abstract

The recent shift from transfemoral access to transradial access in neurointervention has led to gaps in guiding systems. We propose a useful guiding system, the solo distal access catheter system without a conventional guiding catheter or a sheath in transradial access for aneurysms treatment. We also assessed the anatomical features required for suitable patient selection. We retrospectively collected data from consecutive patients with aneurysms treated with the solo distal access catheter system at our institution between April 2022 and April 2023, and evaluated the anatomical factors that appeared to affect the procedure. Of the 20 patients who underwent transradial access, 11 were treated using the solo distal access catheter system, and 10 (90.9%) completed the procedure. No radial artery occlusion was detected. The entry angle of the target vessel ranged from 37° to 139°, and the mean proximal parent artery diameter was 9.34±1.48mm. A double subclavian innominate curve was observed in 3 of 5 patients whose target vessels were the right common carotid artery. Using a solo distal access catheter as a guiding system for treating aneurysm proved effective and feasible with appropriate patient selection. Anatomical assessment of the entry angle of the target vessel, proximal parent artery diameter, and tortuosity may be important factors for the success of this method.