Serial dilation to enable ulnar artery access for endovascular neurointervention: Technical report and systematic review of the literature.

Autor: Brandel MG; Department of Neurosurgery, University of California San Diego, 9300 Campus Point Drive MC 7893, San Diego, CA 92037, USA. Electronic address: mbrandel@health.ucsd.edu., McCann CP; Department of Neurosurgery, University of California San Diego, 9300 Campus Point Drive MC 7893, San Diego, CA 92037, USA., Tucker B; Department of Neurosurgery, University of California San Diego, 9300 Campus Point Drive MC 7893, San Diego, CA 92037, USA., Wali AR; Department of Neurosurgery, University of California San Diego, 9300 Campus Point Drive MC 7893, San Diego, CA 92037, USA., Steinberg JA; Department of Neurosurgery, University of California San Diego, 9300 Campus Point Drive MC 7893, San Diego, CA 92037, USA., Santiago-Dieppa DR; Department of Neurosurgery, University of California San Diego, 9300 Campus Point Drive MC 7893, San Diego, CA 92037, USA., Khalessi AA; Department of Neurosurgery, University of California San Diego, 9300 Campus Point Drive MC 7893, San Diego, CA 92037, USA., Pannell JS; Department of Neurosurgery, University of California San Diego, 9300 Campus Point Drive MC 7893, San Diego, CA 92037, USA.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2024 Nov; Vol. 33 (11), pp. 107900. Date of Electronic Publication: 2024 Jul 29.
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107900
Abstrakt: Background: For rare neuro-endovascular cases in which transfemoral access is not feasible and the palmar circulation is insufficient for radial artery access, ulnar artery access may be considered.
Materials and Methods: Mechanical thrombectomy via ulnar artery access was performed to preserve the dominant radial artery. The ulnar artery was serial dilated to 7-French with microdilator. Angiography was performed using a diagnostic catheter. The sheath was exchanged for a guide catheter, and a triaxial system was inserted. A mechanical thrombectomy was performed. The systematic literature review included all studies pertaining to techniques for ulnar artery access for neurointervention in the last 20 years (2003-2023) published in the PubMed, Web of Science, and Embase databases.
Results: 67-year-old male developed left MCA syndrome in the setting of an infected abdominal aortic endograft. A transfemoral approach was ruled out due to concern for crossing the infected endograft. Allen test and ultrasound demonstrated that the right radial artery was of adequate size for access, but the ulnar artery was insufficient to support the palmar arch. Mechanical thrombectomy resulted in TICI 3 reperfusion. Systematic review of the literature yielded 2 case series and 1 case report of transulnar neurovascular procedures. Access site complications were rare and included 3 access site hematomas and 1 ulnar artery occlusion.
Conclusion: We report our technique of serial dilation of the ulnar artery for neuroendovascular procedures and provide a systematic review of the literature for complication avoidance in ulnar artery access.
Competing Interests: Declaration of competing interest None.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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