Smaller diameter sheaths are required to safely perform transradial neurointerventions

Area of Science:

• Interventional neuroradiology
• Vascular surgery
• Cardiovascular interventions

Background:

• Transradial access for carotid artery stenting (CAS) using a 7F Glidesheath Slender/Envoy Simmons 2 system demonstrates feasibility and a low complication rate.
• The use of large-diameter sheaths in transradial procedures carries a risk of radial artery spasms and severe access site complications.

Discussion:

• Radial artery spasm can necessitate access crossover and lead to complications like artery avulsion, sheath entrapment, and compartment syndrome.
• A 6F Simmons guiding sheath, with a smaller outer diameter than the 7F system, is compatible with large-stent delivery and has shown success in transradial CAS.
• Reducing sheath diameter is crucial for enhancing the safety and applicability of transradial neurointerventions.

Key Insights:

• Transradial CAS is feasible with high success rates.
• Large sheaths increase the risk of radial artery spasm and related complications.
• Smaller sheath diameters are recommended for safer transradial neurointerventions.

Outlook:

• Further research into smaller sheath diameters for transradial neurointerventions is warranted.
• Optimizing sheath technology can expand patient eligibility for minimally invasive CAS procedures.
• Minimizing access site complications is key to advancing transradial techniques in neurointerventional radiology.