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Anatomical navigational difficulties in transradial right carotid artery stenting with 7-F Optimo balloon guide
Kei Arakawa1, Kei Harada1, Masahito Kajihara1
1Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka-city, Japan.
Insights
Navigating the 7-F Optimo balloon guide catheter (BGC) for right carotid artery stenting via the radial artery can be challenging. Specific subclavian artery angles and heights predict these difficulties, aiding procedural planning.
Area of Science:
- Cardiovascular Interventions
- Vascular Surgery
- Interventional Radiology
Background:
- Carotid artery stenting (CAS) is a key treatment for carotid artery stenosis.
- Transradial access using a 7-F Optimo balloon guide catheter (BGC) is a viable approach for CAS.
- Predicting navigational challenges is crucial for procedural success.
Purpose of the Study:
- To investigate factors influencing the difficulty of navigating the 7-F Optimo BGC from the right radial artery to the right common carotid artery during CAS.
- To identify anatomical predictors of navigational difficulty.
Main Methods:
- Retrospective analysis of 40 CAS procedures using a 7-F Optimo BGC via the right radial artery.
- Assessment of pre-operative anatomical measurements, including subclavian artery (SA) height and SA-to-common carotid artery (CCA) angle.
- Comparison of anatomical parameters between groups with easy and difficult BGC navigation.
Main Results:
- Successful BGC navigation in all cases, with difficulties in 17.5% (7/40).
- Difficult navigation was associated with a greater SA height (>34 mm) and a smaller SA-CCA angle (<30°).
- SA height >34 mm and SA-CCA angle <30° demonstrated high sensitivity (100%) and specificity (82%) for predicting navigation difficulty.
Conclusions:
- Transradial CAS with a 7-F Optimo BGC is a safe procedure for right carotid artery stenosis.
- Pre-procedural assessment of SA height and SA-CCA angle can predict BGC navigational challenges.
- Identifying these anatomical risk factors can optimize procedural planning and potentially reduce complications.
Objectives:
Carotid artery stenting (CAS) using a 7-F Optimo balloon guide catheter (BGC) via the right radial artery (RA) was performed for stenosis of the right carotid artery. The factors affecting the difficulty in navigating the BGC from the right RA to the right common carotid artery (CCA) were investigated.
Materials And Methods:
For 40 cases of stenosis of the right carotid artery, CAS using a 7-F Optimo BGC via the right RA was performed. Pre-operative anatomical length and angle of the access route were retrospectively examined.
Results:
The 7-F Optimo BGC successfully reached all lesions; however, navigational difficulties were encountered in seven out of 40 cases (17.5%). One case in the difficult group experienced an ischemic complication. The height from the topmost point of the subclavian artery (SA) to the origin of the SA (SA height) was 44.4 mm versus 28.1 mm (p < 0.01), and the angle between the SA and the CCA (SA-CCA angle) was 21.6° versus 47.9° (p < 0.01) in the difficult and easy groups, respectively. For lesions with difficult navigation, the sensitivity and specificity of the SA height >34 mm were 100% and 82%, and the sensitivity and specificity of the SA-CCA angle <30° were 100% and 82%.
Conclusions:
For stenosis of the right carotid artery, transradial-CAS using a 7-F Optimo BGC is a safe procedure. However, navigating the BGC becomes difficult when the SA height is >34 mm and the SA-CCA angle is <30°.
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