The Ballast radial access system in neuroendovascular procedures: A multicenter investigation of 138 patients

The transradial approach (TRA) for neuroendovascular procedures has gained popularity. There is limited data on the use of large-bore guide catheters in radial approaches. This study evaluates the safety and efficacy of the Ballast 088 long sheath in radial neurointerventional procedures.

We performed a retrospective review of a prospectively maintained neuroendovascular database to assess the Ballast radial access system (Balt USA, LLC) in radial approaches. The primary outcome was technical success, defined as the access catheter reaching its target vessel and completing the procedure without necessitating a shift to femoral access or changing to a different catheter.

There were 138 consecutive patients included in the study. The mean age was 66.7 years (SD ± 15.1); 41.3 % were female. The most common interventions were mechanical thrombectomy for ischemic stroke (31.4 %), carotid stenting for stenosis (24.6 %), and aneurysm embolization (22 %). Challenging anatomic variations included severe vessel tortuosity, type 2 and 3 aortic arch, bovine arch, and a severe angle (<30°) between the subclavian artery and the target vessel. Technical success, defined as reaching the target vessel and successfully completing the procedure without necessitating a shift to femoral access or changing the guide catheter, was achieved in 97.8 % of the cases (135/138). There was one access site complication (temporary spasm; 0.7 %) and no device-related complications.

The use of the Ballast radial access system proved to be safe and feasible. It was successful in treating a wide range of interventional procedures, consistently achieving favorable outcomes via radial access.