Selective use of transradial access for endovascular treatment of severe intracranial vertebrobasilar artery stenosis

• A safe access and stable platform is important for intracranial interventions.
• Transradial access is preferable for selected patients with unfavorable anatomy.
• Transradial approach has advantages for access to the vertebrobasilar system.
• High technical success and low complication rate was demonstrated in our study.

ObjectiveTo study the feasibility and safety of transradial artery access for endovascular intervention of severe intracranial vertebrobasilar stenosis for selected patients not suitable for transfemoral access.MethodsThis was a retrospective analysis of 58 patients who had undergone intervention for severe intracranial vertebrobasilar stenosis using transradial access between January 2012 and September 2014. The reasons for transradial access were traced. The outcome measures were the technical success rate, 30-day stroke or death in the territory of the culprit artery, periprocedural and access site complication rates.ResultsOut of the 58 patients, 19 patients (32.8%) used the transradial approach due to poor iliofemoral artery access, 28 (48.3%) due to unfavorable brachiocephalic or subclavian artery anatomy, 11 (19%) due to unfavorable vertebral artery anatomy. The technical success rate was 100%. There were four periprocedural complications, one of which was asymptomatic. The 30-day stroke rate was 5.2% (3/58 patients), with two of them having no residual neurological deficits. There was no mortality. None had access site complications.ConclusionsFor selected patients with severe intracranial vertebrobasilar stenosis with difficult femoral access or anatomical variations precluding provision of a stable support for intracranial intervention, the transradial approach was shown to be a safe and feasible alternative route of access. Future trials of endovascular treatment for intracranial posterior circulation strokes should take into account the route of access.