Overtake Technique for Navigating 8Fr Emboguard Balloon Guide Catheter for Anterior Circulation Neurointervention

The transradial approach (TRA) using balloon guide catheters (BGCs) has emerged as a neurointerventional option. However, the use of large-bore BGCs may be limited because of the small size of the radial arteries (RAs) and difficulty in navigating BGCs from the right RA to the left anterior circulation. To determine the feasibility and safety of the overtake technique for navigating 8Fr EmboGuard BGCs using the TRA.

We retrospectively reviewed consecutive patients primarily undergoing TRA using EmboGuard BGCs. The BGCs were placed using sheathless or sheath-based methods and navigated by overtaking long Simmons arm inner catheters hooked in the common carotid arteries under the guidance of a half-stiff wire. The minimum diameter of RAs was ≥2.8 mm in all patients. Patient demographics and procedural and clinical outcomes were evaluated at 90 d or later.

Overall, 28 procedures were performed in 26 patients out of 364 procedures in 358 patients. Treatments were successfully completed with the 8Fr EmboGuard TRA in 27 procedures (96.4%) without conversion to the transfemoral approach. In one patient, exchanging the EmboGuard with another BGC was necessary due to herniation of the BGC into the aortic arch during navigation of the carotid stent system. RA occlusion occurred in 1 of 22 patients (3.8%) without ischemic complications.

The overtake technique for navigating the 8Fr EmboGuard BGCs in patients having RAs ≥2.8 mm was feasible and safely performed regardless of the insertion methods.