Bilateral Transradial Access for Complex Posterior Circulation Interventions.

Area of Science:

• Neurosurgery
• Interventional Radiology
• Vascular Surgery

Background:

• Transradial access (TRA) is increasingly favored for neurointerventions due to comparable outcomes and reduced complications versus transfemoral access (TFA).
• Complex neuroendovascular procedures, particularly those involving the posterior circulation, may necessitate simultaneous catheterization of multiple vessels.
• The need for bilateral access sites can arise when single-sided TRA presents technical challenges or when avoiding TFA is preferred.

Observation:

• This report details the first cases of bilateral TRA for complex posterior circulation interventions, specifically left vertebral artery aneurysms.
• Two patients underwent bilateral TRA, utilizing right TRA and left distal transradial access (snuffbox), to facilitate simultaneous catheterization of both vertebral arteries.
• This approach was chosen due to the technical difficulty of left vertebral artery catheterization via right TRA, the necessity for dual access, favorable subclavian artery anatomy, and a preference to avoid TFA.

Findings:

• Bilateral TRA proved effective for selective catheterization of both vertebral arteries in complex posterior circulation interventions.
• The use of distal transradial access allowed for anatomically neutral positioning of the left hand on the operator's side.
• Neither patient experienced any perioperative complications, highlighting the safety of this bilateral approach.

Implications:

• Bilateral TRA presents a viable and safe alternative to TFA when multiple arterial access sites are required for neuroendovascular procedures.
• This technique enhances ergonomic positioning for interventionalists, potentially improving procedural efficiency and safety.
• The findings support the expanded use of bilateral TRA in complex neurointerventions, particularly for posterior circulation pathologies.