Transradial diagnosis and intervention of supraaortic vessels

The transradial approach (TRA) is becoming widespread, mainly for coronary interventions, but it has rarely been used for diagnosis and even less for therapeutic treatment of supraaortic arterial vessel (SAAV) atherosclerotic disease.

We report our last year's experience in both diagnostic and therapeutic endovascular procedures for SAAV atherosclerotic disease using the TRA.

The TRA was used in 20 diagnostic and 18 therapeutic procedures for SAAV atherosclerotic disease performed on 26 males and 12 females with a mean age of 65 ± 7 years. Indications for diagnostic or therapeutic procedures were: clinical findings; and symptoms related to SAAV disease. Indications for the TRA were: no option of femoral approach (9/38); hostile arch anatomy (3/38); technical failure via femoral approach (4/38); ostial vertebral disease (6/38); or patient preference (16/38). All diagnostic procedures were undertaken using 5 Fr catheters. Treated vessels were: brachiocephalic; subclavian; carotid; vertebral; extracranial segments V1 and V2; and intracranial segment V4 and basilar arteries. Technical success was achieved in 17/18 therapeutic procedures (95%). We switched to the femoral approach in 1 patient with right-sided carotid disease where the distal protection device could not be propagated cranial to the narrowed segment. No vascular or neurological complications were recorded in any of the procedures. Patients were discharged the same day after diagnostic procedure and 1 day after therapeutic procedure. At a mean 7-month follow-up exam, neither neurological symptoms nor clinical restenosis were detected.

Diagnostic and therapeutic procedures involving SAAV can be safely and successfully performed via the TRA by experienced interventional cardiologists.