Use of reverse angle guide catheter with trans-radial approach in patients undergoing middle meningeal artery embolization

Use of reverse angle guide catheter with trans-radial approach in patients undergoing middle meningeal artery embolization

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BackgroundTrans-radial access (TRA) for MMA embolization has grown due to lower access Bottle Dishwasher cage site complications and greater patient satisfaction.Here, we describe the feasibility of utilizing a 6F Envoy Simmons 2 (6F-SIM2) as a guide catheter with TRA and compare outcomes with trans-femoral approach (TFA) in a single center case series.MethodsWe performed a retrospective review of patients who underwent MMA embolization for management of chronic subdural hematoma (cSDH).TRA was performed by utilizing a combination of 6F 90cm Envoy (Codman & Shurtleff, Inc., Rayham, MA) Simmons 2 guide catheter and 5F 125cm Sofia (Microvention, Aliso Viejo, CA) intermediate catheter.

Outcomes measured are Modified Rankin Score (mRS) at 90 days, inpatient mortality, post-embolization recurrence, fluoroscopy time and radiation exposure.ResultsA total of 71 patients underwent 97 MMA embolization overall with 65 (67%) in trans-femoral access group, 11 (11.3%) in trans-radial access without use of Simmons 2 Guide catheter group and 21 (21.6%) in trans-radial access with use of Simmons 2 Guide catheter group.There were no direct access-related complications in either group.

One patient had thromboembolic stroke in trans-femoral group.There was no difference in average procedure-related total fluro time or radiation dose among all three groups.ConclusionTrans-radial approach using 6F-SIM2 guide catheter coupled with 5F Sofia intermediate catheter is safe and effective.It provides an alternative approach to access distal branches of bilateral Set Of 3 Storage Jars anterior circulation in elderly patients with difficult anatomy undergoing MMA embolization.