Transradial Approach as the Primary Vascular Access with a 6-Fr Simmons Guiding Sheath for Anterior Circulation Interventions: A Single-Center Case Series of 130 Consecutive Patients

Abstract

TRA with a 6-Fr Simmons guiding sheath for anterior circulation interventions is highly successful and safe for all target CCAs and aortic arch types. This method can be utilized as the primary vascular access for anterior circulation interventions.

Bilateral Distal Transradial Approach for Coiling of Basilar Artery Aneurysm: A Technical Note

“…however, device development and increased experience of operators have led to its application in neuroendovascular procedures in recent years. 5,16) Moreover, in the last few years, dTRA, a less invasive variant of TRA, has been introduced in PCI. 6) In dTRA, the distal radial artery lies under the anatomical snuffbox, a triangular depression surrounded by the tendon of the extensor pollicis longus, extensor pollicis brevis, and the abductor pollicis longus, which is punctured.…”

“…3,4) A certain learning curve is required; however, TRA use has spread due to advances in devices and increased experience of operators. 5) More recently, the distal transradial approach (dTRA), an advanced version of TRA, has been introduced in interventional cardiology. 6) In dTRA, the radial artery is punctured in the anatomical snuffbox more distally than that in conventional TRA.…”

Letter: Lessons Learned After 760 Neurointerventions via the Upper Extremity Vasculature: Pearls and Pitfalls

“…1 TRA can be technically challenging in patients with an unfavorable steep takeoff of the target common carotid artery (CCA), including those with right CCA lesions with steep angulation to the right subclavian artery via right TRA or those with nonbovine left CCA lesions via right or left TRA. [1][2][3][4] In such cases, a conventional "straight-shaped" guiding system can herniate into the aortic arch and/or can lead to catheter kinking.…”

“…We have employed TRA as the first-line approach-a radialfirst strategy-for therapeutic neurointerventions, including anterior circulation interventions. [2][3][4][5][6][7][8] We previously described that the first-line TRA with a 6F "preshaped" Simmons guiding sheath (2.70 mm outer diameter, 0.088 inch inner diameter, 6F Axcelguide Stiff-J, 90 cm; Medikit, Tokyo, Japan) provides a large-bore working channel and a high procedural success rate without catheter kinking or system instability, regardless of the aortic arch type, target CCA, and access side. [2][3][4] The 6F Simmons guiding sheath is a radial-specific neurointerventional sheathless guiding catheter especially designed for CCA cannulation.…”

“…Based on the target CCA and access side, the push-in or pull-back technique is used for CCA cannulation. [2][3][4] The push-in technique is a procedure to coaxially advance a 6F Simmons guiding sheath with a push-in maneuver. The pull-back technique, which is technically straightforward and unique to this radial-specific neurointerventional guiding sheath, is a procedure to coaxially deliver a 6F Simmons guiding sheath with a pull-back maneuver after the re-formation of the natural reversed curve (Simmons curve) within the ascending aorta.…”