A transradial approach directly using a distal access catheter for symptomatic intracranial vertebral artery and basilar artery stenosis: A single-center study

This study primarily reports our single-center experience and technical procedures involving the direct use of a distal access catheter (DAC) via the transradial approach (TRA) for treating symptomatic intracranial vertebral (VA) and basilar (BA) artery stenosis and to evaluate factors influencing the success rate of establishing a TRA.

A retrospective analysis was conducted on 62 patients who underwent endovascular treatment for symptomatic intracranial VA and BA stenosis between June 2021 and March 2023. Patients were divided into TRA and transfemoral approach (TFA) groups. Patient characteristics and radiographic and clinical information were reviewed. In the TRA group, subgroup analysis was performed based on whether the DAC was shaped to compare the significant differences between the two groups.

There were no significant differences in procedural success rates or complication rates between the two groups. However, the proportion of smokers and the rate of access catheter use were higher in the TRA group than in the TFA group. The VA take-off angle was also greater in the TRA group. The TRA subgroup analysis showed that the VA take-off angle of the subgroup whose DACs did not require shaping was greater (109.57 ± 28.63° vs. 62.8 ± 21.57°, p < 0.001), and the subclavian artery height was shorter (6.13 ± 4.31 mm vs. 13.58 ± 7.35 mm, p = 0.002). The VA take-off angle and subclavian artery height cutoff values were 68.7° and 8.64 mm, respectively.

This study reveals that directly using a DAC via the TRA without guiding support is safe and effective for treating symptomatic intracranial VA and BA stenosis. A higher success rate of TRA can be achieved when the VA take-off angle is greater than 68.7° and the ipsilateral subclavian artery height is less than 8.64 mm.