Usefulness of a Novel Technique to Make Up for a Deficiency in Transradial Neurointervention with a 6Fr Simmonds Guiding Sheath: Original Experience with the Subclavian Artery Anchoring Technique

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

“…From June 2018, we selected right TRA as the first-line, left TRA as the second-line, and TFA as the third-line vascular access during neurointerventions for anterior circulation lesions including carotid artery stenting (CAS) and cerebral aneurysm coiling at our institute. The selection criteria to prioritize TRA have been described previously 25 : (1) favorable access routes were confirmed based on preprocedural images, (2) the pulsation of the radial artery was detected, and (3) the Allen test was negative. Patients who fulfilled all these criteria were selected as favorable candidates for TRA (Figure 1).…”

“…A 6-Fr Simmons guiding sheath (6-Fr Axcelguide Stiff-J-1 or Stiff-J-2 90 cm; Medikit, Tokyo, Japan) was used in this study (Figure 2). [22][23][24][25] This 6-Fr Simmons guiding sheath is commercially available only in Japan.…”

“…22 The pull-back technique is a procedure to coaxially deliver a 6-Fr Simmons guiding sheath using a pull-back maneuver after reformation of the natural reversed curve (Simmons curve) within the ascending aorta (Video 2). [22][23][24][25] Three reformation techniques to shape the Simmons curve were used ORIGINAL ARTICLE (Figure 4): (1) "descending aorta anchoring" technique (DAT) (Video 3), (2) "subclavian artery anchoring" technique (SCAT) (Video 4), and (3) SCAT with snare (Video 5). [22][23][24][25] DAT was used for patients with a type II/III arch 26 treated with right TRA.…”

“…[22][23][24][25] Three reformation techniques to shape the Simmons curve were used ORIGINAL ARTICLE (Figure 4): (1) "descending aorta anchoring" technique (DAT) (Video 3), (2) "subclavian artery anchoring" technique (SCAT) (Video 4), and (3) SCAT with snare (Video 5). [22][23][24][25] DAT was used for patients with a type II/III arch 26 treated with right TRA. SCAT was used for patients with a type I arch 26 treated with right or left TRA and SCAT with snare was used for patients with a type II/III arch treated with left TRA.…”

“…10,11,[13][14][15][16]21 We previously reported that TRA with a 6-Fr "Simmons-shaped" guiding sheath was useful even in such challenging conditions because a pre-shaped Simmons curve provides kink resistance and high stability. [22][23][24][25] The purpose of the present study was to evaluate the feasibility and safety of neurointerventional TRA as the primary vascular access with a 6-Fr Simmons guiding sheath specifically designed for transradial carotid cannulation.…”