Manual reduction of a radial artery loop under direct fluoroscopic visualization

Area of Science:

• Interventional Neurology
• Vascular Surgery
• Radiology

Background:

• Transradial access (TRA) is increasingly preferred for neurointerventions due to lower access site complications.
• Radial artery anomalies, such as loops, can pose significant navigation challenges, potentially requiring conversion to femoral access.

Observation:

• A case involving a patient in her 70s undergoing carotid body tumor embolization via right TRA is presented.
• A radial artery loop was identified during angiography, which resisted spontaneous reduction after standard navigation techniques.

Findings:

• A triaxial system successfully navigated the radial artery loop.
• Manual manipulation of catheters in the antecubital fossa under fluoroscopic guidance effectively reduced the loop, allowing the procedure to proceed transradially.

Implications:

• This case highlights manual catheter manipulation as a viable technique for resolving challenging radial artery loops when standard methods fail.
• Attempting manual reduction before converting to femoral access may preserve the benefits of transradial access in complex neurointerventional cases.