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Alternative access for endovascular treatment of cerebrovascular diseases
Badih Daou1, Nohra Chalouhi1, Stavropoula Tjoumakaris1
1Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
Insights
Alternative access routes like transradial, transcervical, and superior ophthalmic vein (SOV) approaches are safe and effective for neuro-endovascular interventions when standard methods fail. These techniques successfully treated aneurysms, arteriovenous malformations, and acute stroke.
Area of Science:
- Neurosurgery
- Endovascular Interventions
- Cerebrovascular Diseases
Background:
- Limited data exists on the role of alternative access routes in neuro-endovascular procedures.
- Standard transfemoral access may not always be feasible for managing complex cerebrovascular pathologies.
Purpose of the Study:
- To evaluate the safety and efficacy of alternative access techniques in endovascular management of cerebrovascular diseases.
- To assess outcomes of transradial, transcervical, and superior ophthalmic vein (SOV) access in neuro-endovascular interventions.
Main Methods:
- Retrospective analysis of 29 patients undergoing endovascular interventions via alternative access routes.
- Techniques included transradial, transcervical with carotid cutdown, and superior ophthalmic vein (SOV) access.
- Interventions managed intracranial pathologies such as aneurysms, arteriovenous malformations, acute stroke, and carotid-cavernous fistulas.
Main Results:
- Transradial access successfully treated aneurysms, arteriovenous malformations, and acute stroke with high obliteration/recanalization rates and no access-related complications.
- Transcervical access was used for 6 aneurysms without complications.
- SOV cutdown successfully treated 16 carotid-cavernous fistulas with complete obliteration in most cases; one patient experienced transient elevated intra-ocular pressure.
Conclusions:
- Alternative access routes, including transradial, transcervical with carotid cutdown, and SOV access, are safe and effective.
- These methods provide viable options for managing diverse cerebrovascular lesions when transfemoral access is not possible.
Objective:
Data regarding the role of alternative access routes in neuro-endovascular interventions is limited. Our aim is to evaluate the safety and efficacy of alternative access in endovascular management of cerebrovascular diseases.
Methods:
29 patients who underwent endovascular interventions using alternative access techniques including transradial, transcervical with carotid cutdown and access through the superior ophthalmic vein (SOV) to manage various intracranial pathologies were retrospectively identified.
Results:
The mean patient age was 68 years. Mean follow-up was 6.6 months. The transradial approach was successfully used in the management of 3 aneurysms using the pipeline embolization device (PED), coiling and stent-assisted coiling, 2 arteriovenous malformations (AVMs) using Onyx embolization and 2 acute stroke interventions. This resulted in complete obliteration of 3 lesions and near complete occlusion (>90%) of 2 lesions and successful recanalization in the 2 patients with stroke. There were no access related complications. Transcervical access was successfully used to treat 6 aneurysms using the PED or coiling embolization without any complications. SOV cutdown followed by endovascular embolization was performed successfully in 16 patients harboring carotid-cavernous fistulas (CCFs) using Onyx embolization alone in 12 cases and Onyx with coiling in 4 patients. Complete obliteration was achieved in 14CCFs and near complete obliteration in 2CCFs. Complications occurred in 1 patient who had transient elevated intra-ocular pressure postoperatively.
Conclusions:
When transfemoral access fails, alternative access routes using transradial, transcervical with carotid cutdown and access through the SOV can be safe and effective for managing various cerebrovascular lesions.
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