Transradial access of neuro-endovascular interventions with aberrant right subclavian arteries: Case series and literature review

Abstract

Introduction

Transradial artery access (TRA) reduces puncture site complications and is becoming standard in neuro-endovascular procedures. An aberrant right subclavian artery (ARSA) is a congenital anomaly affecting 0.5% to 2% of the population, complicating cerebral angiography via TRA.

Case presentation

Three cases of neuro-endovascular treatment involving ARSA and TRA are reported. In the first case, ARSA was detected during the induction of a 7Fr RIST from the right distal radial artery (dRA), and treatment continued with transfemoral access. In the second case, ARSA was identified pre-interventionally, and a left dRA approach was selected with a 6Fr Axcelguide Stiff-J with pulling-up methods. The third case involved the successful induction of a 7Fr RIST with some tips to the right internal carotid artery, followed by the placement of a flow diverter.

Discussion

ARSA, a congenital anomaly, complicates TRA due to its abnormal bifurcation. Cerebral angiography with ARSA is challenging, often requiring alternative access routes. We gathered our 3 reports and the 11 literature reports, with 3 switching to femoral access due to the difficulty of catheter navigation. Two guiding methods in TRA are discussed, with the “pull-back technique” often applied with the Simmonds-type guiding catheter but sometimes ineffective.

Conclusion

Three neuro-interventional cases with TRA and ARSA are presented, with two successful treatments. The limited cases underscore the need for preoperative access route examination and the development of alternative methods in case of failure. This urgency highlights the importance of ongoing research and innovation in the field.