Dual-center study comparing transradial and transfemoral approaches for flow diversion treatment of intracranial aneurysms

Priyank Khandelwal, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Neil Majmundar, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.Follow
Gustavo J. Rodriguez, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Pratit Patel, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Vincent Dodson, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Amit Singla, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Rakesh Khatri, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Vikas Gupta, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Faheem Sheriff, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Anantha Vellipuram, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Salvador Cruz-Flores, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Alberto Maud, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.

Document Type

Article

Abstract

BACKGROUND: The transfemoral approach (TFA) has been the traditional approach for neurointerventional cases. While the TFA allows for triaxial support in flow diverting stent cases, it is associated with access site complications. Recently, the transradial approach (TRA) has emerged as a safer alternative to the TFA. To the best of our knowledge, there have only been single-center studies comparing outcomes in flow diverter cases for these approaches. We demonstrate the safety and feasibility of the TRA for placement of flow diverting stents in the treatment of unruptured intracranial aneurysms at two high-volume centers. MATERIALS AND METHODS: We performed a retrospective review of prospectively collected institutional databases at two high-volume neuroendovascular centers. Cases from 2016 to 2018 of unruptured intracranial aneurysms treated by flow diverting stenting accessed through either the TRA or the TFA were compared. Patient demographics, procedural and radiographic metrics including location and size of the aneurysm, size, and length of the flow diverter implant, and fluoroscopic time were recorded. Puncture site complications and length of hospital stay were also included in the data analysis. RESULTS: There were three out of 29 TRA cases which were converted to the TFA. None of the TRA patients experienced site complications, whereas three TFA patients experienced site complications. While TRA and TFA patients did not differ significantly in their exposure to radiation, TRA patients experienced shorter hospital stays. CONCLUSIONS: While long-term studies are still lacking regarding this approach, we demonstrate that the TRA is a safe and feasible approach for flow diverter stent placement.

Publication Date

1-1-2021

Publication Title

Brain circulation

E-ISSN

2455-4626

Volume

7

Issue

2

First Page

65

Last Page

70

PubMed ID

34189348

Digital Object Identifier (DOI)

10.4103/bc.bc_38_20

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