Related Experiment Video
Updated: Oct 6, 2025
A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application
Published on: July 9, 2020
Anatomical Factors That Impede Using the Radial Artery Approach for Carotid Artery Revascularization
Takeshi Uno1, Masaaki Shojima2, Yuta Oyama2
1Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan; Department of Neurosurgery, Yaentoge Neurosurgical Hospital, Tokyo, Japan.
Insights
The radial artery approach (RAA) is more challenging for left-sided craniocervical interventions due to anatomical factors. A smaller angle between the brachiocephalic artery and aortic arch increases difficulty and instability during catheterization.
Area of Science:
- Vascular Surgery
- Interventional Neuroradiology
- Anatomical Studies
Background:
- The radial artery approach (RAA) is increasingly used for endovascular procedures.
- Craniocervical interventions present unique anatomical challenges.
- Understanding these challenges is crucial for optimizing procedural success.
Purpose of the Study:
- To investigate anatomical factors complicating the radial artery approach (RAA) in craniocervical intravascular interventions.
- To assess the success rates and difficulties associated with RAA for left-sided versus right-sided lesions.
Main Methods:
- Evaluation of data from 65 patients (73 lesions) undergoing transradial cervical carotid artery intervention.
- Assessment of anatomical parameters including vessel diameters and angles (common carotid, aortic, brachiocephalic, subclavian arteries).
- Comparison of RAA success rates and difficulties between right-sided and left-sided lesions.
Main Results:
- RAA was difficult in 13.7% of cases, significantly more so for left-sided (24.2%) than right-sided lesions (5.0%).
- A small angle between the brachiocephalic artery and aortic arch was a major factor in difficulty for left-sided lesions (P=0.0001).
- Catheter instability and need for femoral artery crossover occurred in a small percentage of cases.
Conclusions:
- The radial artery approach is technically more demanding for left-sided craniocervical interventions.
- Anatomical variations, particularly the brachiocephalic-aortic arch angle, are key determinants of RAA success and stability.
- These findings aid in predicting and mitigating challenges in RAA for craniocervical procedures.
Objectives:
We investigated the anatomical characteristics that complicate utilizing the radial artery approach (RAA) for craniocervical intravascular intervention.
Methods:
The data of 73 lesions in 65 consecutive patients who underwent transradial cervical carotid artery intervention was evaluated. We assessed the success rate of RAA in right-sided and left-sided lesions. The diameters and angles of the left and right common carotid arteries and the aortic, brachiocephalic, and right subclavian arteries, which constitute the paths of the guiding sheath, were assessed for each of the left- and right-sided lesions.
Results:
It was difficult to apply RAA in 10 cases (13.7%), of which 2 (5.0%) involved right-sided and 8 (24.2%) left-sided lesions. The approach was significantly more difficult to perform in left-sided than in right-sided lesions (P = 0.02). Although the treatments were successfully completed, crossover to the femoral artery approach was required in 4 cases (5.5%, 2 cases for left-sided lesions). Placement of the guiding sheath in the common carotid artery was successful for all right-sided lesions; however, the guiding sheath slipped off to the aorta during stent advancement in 2 cases. When the angle between the brachiocephalic artery and aortic arch was small, the introduction of the guiding sheath to left-sided lesions was difficult in eight cases (P = 0.0001).
Conclusions:
RAA was difficult to perform in cases involving left-sided lesions and a small angle between the brachiocephalic artery and aortic arch. This study could help delineate the factors associated with difficulty of catheter introduction and instability of RAA.
Related Concept Videos
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:12Arteries of the Upper Limbs
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:10The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...