Transradial approach for vertebral artery stenting: technical case report
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Published on: September 20, 2020
R D Fessler1, A K Wakhloo, G Lanzino
1Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, USA. rfessler@neurosurgery.wayne.edu
Objective:
We report the technique of transradial vertebral artery stenting for two patients in whom severe supra-aortic ectasia prevented ready access to the right vertebral artery origin.
Methods:
An Allen test was performed to verify ulnar artery collateral flow in the hand. After the administration of local anesthesia, a 6-French sheath was introduced into the radial artery. To allay induced spasm, a mixture of heparin (5000 IU/ml), verapamil (2.5 mg), nitroglycerine (400 microg/ml, 0.25 ml), and lidocaine (2%, 1.0 ml) was infused through the introducer sheath. A microguidewire was positioned across the vertebral artery lesion, followed by placement of a balloon-expandable stent.
Results:
Postdeployment angiography revealed improved vertebrobasilar system flow. There were no complications related to the radial artery. The patients tolerated the procedure without difficulty and were immediately ambulatory.
Conclusion:
This novel approach should be considered for endovascular procedures for which access to the vertebral artery origin via the femoral approach is limited.