Cervical Positional Changes Alter Supra-Aortic Branching Geometry: Implications for Transradial Neurointervention

Area of Science:

• Neurointerventional radiology
• Vascular imaging and anatomy

Background:

• Transradial approach is favored in neurointerventions due to fewer access-site complications.
• Catheterizing supra-aortic vessels poses challenges, particularly with difficult vascular anatomy.
• The impact of neck positioning on supra-aortic vessel angles is not well understood.

Purpose of the Study:

• To quantitatively assess how changes in cervical position affect supra-aortic branching angles.
• To evaluate the potential of positional adjustments for improving catheter navigation in neurointerventions.

Main Methods:

• Prospective observational study involving 77 patients.
• Three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) was used.
• Measurements of supra-aortic branching angles in five positions: neutral, rotation (left/right), flexion, and extension.

Main Results:

• Significant changes in the right SCA-CCA bifurcation angle were observed with rotation and extension/flexion.
• The brachiocephalic artery, left CCA, and left SCA showed minimal angular variations.
• Positional differences were most pronounced in the right SCA-CCA segment, with no significant changes in proximal branches.

Conclusions:

• Cervical positioning demonstrably influences supra-aortic branching geometry, particularly the right SCA-CCA bifurcation.
• Simple head and neck movements can optimize vascular access.
• These findings support using positional adjustments as a practical strategy to facilitate catheter navigation in right transradial neurointerventions.