Feasibility and Safety of High RIST Catheter Placement via Transradial Approach for Unruptured Anterior Circulation Aneurysm: A Single-center Era-based Retrospective Study.
Transradial approach using a high RIST placement appears feasible and safe, achieving high success and low complication rates.
Abstract
The transradial approach using dedicated guiding catheters, such as the RIST guiding catheter, has gained popularity in neuroendovascular treatment. However, concerns remain regarding system instability. We evaluated the feasibility and safety of transradial approach with advancement of the RIST to a higher and more stable position (petrous to cavernous segment of the internal carotid artery). We conducted a single-center, retrospective, era-based cohort study comparing a transfemoral approach-first era (2022-2023) with a transradial approach with high RIST placement-first era (2024-2025). Consecutive adult patients who underwent endovascular treatment for unruptured intracranial aneurysms were included. After the exclusion of posterior circulation and ruptured aneurysms, 171 procedures (96 transfemoral approach and 75 transradial approach) were analyzed. The primary outcome was procedural success. Safety outcomes included neurological complications, access-site complications, and 30-day mortality. The primary analysis was era-based; sensitivity analyses were performed per protocol, and subgroup analyses focused on lesion laterality. In the transradial approach-first era, the procedural success rate was 99% (odds ratio 1.57, 95% confidence interval 0.14-17.70, p > 0.99), neurological complications occurred in 3%, access-site complications in 3%, and 30-day mortality in 0%, comparable to those in the transfemoral approach-first era. Sensitivity analyses restricted to cases with high RIST placement yielded similar results. The subgroup analysis did not reveal any interaction between outcomes and lesion laterality; The P-values for interaction were 0.294 for procedural success, 0.079 for periprocedural neurological complications, and 0.176 for access-site complications. Transradial approach using a high RIST placement appears feasible and safe, achieving high success and low complication rates.
OBJECTIVE
To assess technical feasibility and procedural features of the Amplatz Left (AL) guiding catheter-assisted partial deployment (ATTAIN) technique for selected right-sided low-origin vertebral artery ostial stenosis (VAOS).
METHODS
We prospectively studied 10 consecutive patients. Technical success required accurate balloon-expandable drug-eluting stent placement and expansion without access crossover, guide-catheter exchange, or salvage techniques. Safety outcomes included 30-day neurological and access-site events and follow-up stent-related events. Preprocedural assessment considered vertical ostial depth (VOD) and subclavian-vertebral geometry.
RESULTS
During the 17-month enrollment period, technical success was achieved in 9 of 10 patients (90%). Median age was 71.5 years (IQR, 69-74); median VOD was 12.5 mm (IQR, 11-16). Among successful procedures, median deployment time was 28 minutes (IQR, 22-32). Median stenosis decreased from 76.5% (IQR, 73%-83%) to 2.5% (IQR, 0%-9%). At 3 months, symptoms completely resolved in 6 patients, partially improved in 2, and remained unchanged in 2; all had modified Rankin Scale scores of 0 or 1. No clinically apparent stroke, transient ischemic attack, or death occurred within 30 days; one unconfirmed minor access-site event was recorded. At a median 8-month follow-up (IQR, 5-11; range, 3-15), 9 patients underwent imaging, no stent fracture or in-stent restenosis was identified.
CONCLUSIONS
In this proof-of-concept series, the ATTAIN technique showed preliminary feasibility and provided a standardized AL guiding-catheter-assisted deployment sequence for selected right-sided low-origin VAOS. Comparative efficacy, definitive safety, and left-sided applicability remain unestablished.
Han-Ming Ge, Xiao-Bo Zhang, Zhanhua Liang et al.· World Neurosurgery· 0 citations
Background Endovascular recanalization of non-acute internal carotid artery occlusion (NA-ICAO) remains technically challenging. This technical report describes the Balloon-Assisted Catheter Advancement (BACAT) technique and evaluates its procedural feasibility in a small, heterogenous patient cohort. Methods We retrospectively reviewed 15 patients with NA-ICAO who underwent BACAT-assisted recanalization. Cases included both pure endovascular therapy (n = 8) and hybrid therapy combined open surgery with endovascualr therapy (n = 7). The primary outcome was technical success, defined as successful antegrade passage of the catheter across the occlusive segment using the BACAT maneuver. Procedural complications were recorded descriptively. Results Technical success was achieved in 13 of 15 patients (86.7%). No intraprocedural rupture or flow-limiting dissection occurred. One non-disabling postoperative stroke (6.7%) was observed in the hybrid subgroup. Given the small sample, absence of a control group, and case heterogeneity, no statistical comparisons or efficacy claims are made. Conclusions The BACAT technique appears technically feasible for selected patients with NA-ICAO, including both pure endovascular therapy and hybrid surgical. This report provides procedural details to facilitate replication and further investigation. Clinical efficacy and comparative safety require validation in larger, controlled studies.
Yufeng Wang, Yixin Sun, Ruilin Ren et al.· Frontiers in Surgery· 0 citations
PURPOSE
To report real-world outcomes of a safety-oriented, endovascular-first strategy for proximal atherosclerotic subclavian artery chronic total occlusion (CTO) and to develop a pragmatic computed tomography angiography (CTA)-based open-first consideration aid for anatomically unfavorable cases.
MATERIALS AND METHODS
This single-center retrospective study included consecutive patients treated between January 2020 and December 2024. Endovascular-first revascularization was pursued when feasible, with bypass used as primary therapy or after failed endovascular attempts. Computed tomographic angiography morphology was assessed using prespecified definitions. Factors associated with endovascular technical success were evaluated using logistic regression. Hemodynamically significant restenosis during follow-up was defined as recurrence or progression of inter-arm systolic blood pressure difference ≥20 mm Hg relative to the post-discharge baseline. Time-to-event outcomes were assessed using Kaplan-Meier analysis. A CTA-based open-first consideration score (0-4) was derived among patients undergoing definitive revascularization (bypass vs successful endovascular repair).
RESULTS
Among 122 patients, endovascular-first treatment was attempted in 101, with technical success in 75 (74.3%); definitive revascularization was achieved in 112 patients (91.8%) after inclusion of bypass. Right-sided laterality, absent proximal stump (<3 mm), and severe calcification were independently associated with endovascular technical failure. Periprocedural morbidity was low, with no clinically apparent stroke or transient ischemic attack; 1 localized type B aortic injury after endovascular repair and 1 lymphatic leak after bypass were managed conservatively. During a median follow-up of 26 months, estimated restenosis was approximately 10% at 1 year and 22% at 3 years, whereas clinically driven reintervention remained low at approximately 3% and 6%, respectively. The CTA-based open-first consideration score showed good discrimination for bypass selection (area under the curve, 0.887), with ≥2 points serving as a high-specificity prompt for bypass consideration.
CONCLUSIONS
In proximal subclavian CTO, a safety-oriented endovascular-first strategy achieved acceptable technical success, low clinically apparent neurologic morbidity, and low reintervention during mid-term follow-up. A CTA-based open-first consideration score may help identify anatomically unfavorable cases for bypass consideration and define escalation boundaries, and warrants external validation.Clinical ImpactThis study supports a safety-oriented, endovascular-first approach for proximal subclavian artery chronic total occlusion, while emphasizing that endovascular and surgical revascularization should be considered complementary rather than competing strategies. Preprocedural CTA can identify anatomically unfavorable lesions in which prolonged endovascular escalation may reduce the procedural safety margin. The proposed CTA-based open-first consideration score provides a simple framework to support treatment planning, patient counseling, and predefined stopping boundaries. Clinically, this approach may help operators avoid unnecessarily aggressive recanalization attempts while preserving endovascular therapy for patients with favorable anatomy.
Tao Shi, Jie Fang, Mingyao Luo et al.· Journal of Endovascular Ther...· 0 citations
Background: The transradial approach is gaining popularity for reduced access-site complications, but radial artery occlusion (RAO) remains a concern. The distal transradial approach (dTRA) may preserve patency better than conventional (cTRA). This study aim was to compare RAO rates and procedural outcomes between dTRA and cTRA. Methods: This prospective observational study was conducted at NICVD, Dhaka, from March 2018 to February 2019. A total of 200 patients undergoing coronary angiography and/or percutaneous coronary intervention were divided into two equal groups: Group I (dTRA, n=100) and Group II (cTRA, n=100). Procedural variables, complications, and RAO were assessed. RAO was confirmed by duplex Doppler ultrasonography on the first post-procedural day. Multivariate logistic regression was performed to identify independent predictors of RAO. Results: Puncture time was significantly longer in dTRA (1.91±0.15 vs. 1.79±0.11 min, p=0.001), while hemostasis time was significantly shorter for both CAG (7.5±2.9 vs. 10.0±3.5 min, p=0.03) and PCI (19.0±5.6 vs. 23.0±7.2 min, p=0.03). RAO occurred significantly less in dTRA compared to cTRA (1.0% vs. 5.0%, p=0.04). Independent predictors of RAO included prolonged hemostatic compression time (OR: 8.48 for >4 hours in PCI), procedure time (OR: 1.44), access site complications (OR: 4.89), and cTRA (OR: 5.21, p=0.04). Conclusion: The distal transradial approach is a safe and feasible alternative to the conventional approach, offering significantly lower RAO rates, shorter hemostasis time, and fewer complications despite a slightly longer puncture time. It should be preferred when radial artery preservation is a priority.
Tamal Peter Ghosh, M. Uddin, Luthfun Nahar Lipy et al.· SAS Journal of Medicine· 0 citations
OBJECTIVES
Transcatheter aortic valve Implantation (TAVI) via the transfemoral approach is widely used. However, patients with unsuitable peripheral arterial anatomy require alternative transthoracic access. In such patients, the right mini-thoracotomy transaortic (Rt-TAo) approach offers a less invasive option than conventional sternotomy. Therefore, this study aimed to evaluate the procedural and 2-year clinical outcomes of transfemoral (TF) TAVI versus Rt-TAo TAVI.
METHODS
Patients who underwent TAVI via the TF approach or Rt-TAo approach between January 2012 and November 2023 were retrospectively reviewed. Baseline characteristics and clinical outcomes were compared, and propensity score matching was performed to adjust for baseline differences. The primary endpoints were in-hospital mortality, stroke, other periprocedural morbidities, and postprocedural length of hospitalization. Secondary endpoints included overall survival, freedom from cardiac-related death, and major adverse cardiac and cerebrovascular events (MACCE) at 2 years.
RESULTS
A total of 767 consecutive patients were included in the analysis, of whom 694 underwent TF TAVI and 73 underwent Rt-TAo TAVI. Before matching, the Rt-TAo group had higher baseline prevalences of comorbidities and Society of Thoracic Surgeon risk scores. After matching, the Rt-TAo group had a longer procedural time, higher transfusion requirements, and longer lengths of intensive care unit and total hospital stays. However, the 2 groups had similar rates of periprocedural stroke, coronary obstruction, annular rupture, access-related complications, and in-hospital mortality. The 2 groups had similar 2-year rates of survival and freedom from MACCE.
CONCLUSIONS
The Rt-Tao TAVI is a safe and feasible alternative for patients with unsuitable peripheral arterial access, demonstrating comparable 2-year outcomes to TF TAVI.
N. Kawamoto, Kizuku Yamashita, Kota Suzuki et al.· Interdisciplinary cardiovasc...· 0 citations
Trans-ankle intervention (TAI) through retrograde distal access via below-the-knee and below-the-ankle arteries has been increasingly reported as an alternative approach for the treatment of femoropopliteal (FP) lesions. Although previous studies have described the procedural success of this strategy, its clinical feasibility and post-procedural outcomes remain insufficiently characterized. In this retrospective single-center study, the data from 33 patients with 36 FP lesions who underwent endovascular therapy (EVT) between January 2024 and January 2025 were analyzed. The primary endpoint was procedural success. The secondary endpoints were clinical worsening of lower-limb ischemia within 30 days, 1-year freedom from clinically driven target lesion revascularization (CD-TLR), and procedural complications. The risk of post-procedure access vessel occlusion was also investigated. TAI was performed via access sites ranging from the anterior tibial artery (ATA) to the dorsalis pedis artery in all patients. Procedural success was achieved in all cases, and the rate of 1-year freedom from CD-TLR was 91.8%. All patients had FP lesions, including three cases up to the iliac artery. Forty-two percent was chronic total occlusion, and EVT of the ATA was required in 42% of the cases to establish the access route. Ten cases (27.8%) were approached via the occluded pre-ATA, and 15 (41.7%) required intervention to approach the vessel. The average number of pre-procedural and post-procedural below-the-knee artery runoff vessels was 2.4 and 2.75, respectively. No patients showed clinical worsening within 30 days. The risk factors for ATA occlusion were hemodialysis, ATA intervention, and approach via the occluded ATA. TAI may represent a feasible result, especially for selected FP lesions. Although no clinical worsening was observed, an increased risk of postoperative ATA occlusion existed in patients on hemodialysis and those with access site atherosclerosis requiring ATA intervention. However, in these high-risk populations, this limitation may potentially be overcome by an approach through the occluded ATA.
H. Miwa, N. Hayakawa, Toshiki Tsurumaki et al.· CVIR Endovascular· 0 citations