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Transradial approach for stenting of vertebrobasilar stenosis: a feasibility study
Tejas Patel1, Sanjay Shah, Hemant Malhotra
1Total Cardiovascular Solutions Private Limited, Ahmedabad, Gujarat, India. tejaspatel@tcvsgroup.org
Background:
Endovascular intervention of vertebrobasilar stenosis is a relatively new but alternative modality of management, supported by very few studies and case reports. Femoral approach has been used in all. The purpose of present study is to evaluate feasibility of the radial artery as an alternative approach for vertebral artery stenting (VAS) and basilar artery stenting (BAS).
Methods:
Forty-seven patients (mean age 70 +/- 5, 38 male) underwent VAS and BAS. VAS was offered in 42 and BAS was offered in five patients. All the patients were symptomatic having stenosis greater than 75%. The target vertebral artery (VA) was cannulated using a 6Fr Internal Mammary Artery (IMA) guide catheter using ipsilateral radial approach. 0.014'' floppy tip coronary guide wire was advanced and parked across the culprit stenosis. Pre dilation was done using a 2 x 12 mm(2) or a 2.5 x 12 mm(2) PTCA catheter and balloon mounted 2.5 x 13 mm(2) or 3 x 13 mm(2) bare metal stent was deployed using 8-10 atm pressure for all chronic lesions. For acute occlusions, the procedure was divided in two stages. In first stage, the lesion was dilated using PTCA catheter (1.5 x 12 mm(2)) at 4-6 atm pressure just to establish the distal flow. After 24 hr, the patient was brought back and the culprit lesion was stented using 8-10 atm pressure. The procedure was staged to prevent hyperperfusion brain injury.
Results:
VAS was successful in 42/42 (100%) patients. BAS was successful in five out of five (100%) patients. However, three patients had transient periprocedural stroke which recovered completely within 6 hr and one patient developed intracerebral hemorrhage (ICH) who died after 24 hr. Hyper perfusion brain injury was the cause for ICH.
Conclusion:
VAS and BAS using the transradial approach appear to be safe, technically feasible, and reproducible. Technical ease of cannulation of vertebral artery with IMA guide catheter using ipsilateral transradial approach should make it more convenient when compared with femoral approach.
