A novel peel-away sheath technique for sheathless transradial use of 8 Fr balloon guide catheter

ObjectiveTo evaluate a novel peel-away sheath technique for sheathless transradial delivery of an 8 Fr balloon guide catheter (BGC), using a 6 Fr peel-away sheath and a 6 Fr inner catheter, without requiring device exchange or dedicated inner dilators.MethodsIn this technique, a 6 Fr peel-away sheath is first inserted into the radial artery, through which a 6 Fr inner catheter and guidewire are advanced. The sheath is then peeled and removed. The preloaded 8 Fr BGC (Branchor X), coaxially mounted over the inner catheter, is subsequently advanced into the radial artery. We retrospectively analyzed 10 consecutive patients who underwent neuroendovascular procedures using this technique.ResultsThe median patient age was 80 years (interquartile range [IQR], 75-88), with 5 males (50%). The peel-away sheath technique was technically successful in all cases (100%), with the BGC successfully delivered via transradial or transulnar access, navigated to the target vessel, and the intended procedure completed without the need for access conversion or device substitution. The median navigation time was 16 min (IQR, 10-24). Balloon inflation was performed in 5 cases (50%) for proximal flow arrest during thrombectomy, distal embolic protection during carotid artery stenting, or device delivery support during aneurysm treatment. No major access-related complications occurred, and no new permanent neurological deficits were observed.ConclusionsThis peel-away sheath technique provides a safe, efficient, and reproducible method for transradial 8 Fr BGC delivery using commonly available devices, potentially expanding the feasibility of transradial access in neuroendovascular practice.