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

Neeharika Krothapalli; Mohamad Fayad; Smit Patel; Ahmed Elmashad; Eric Sussman; Charles Bruno; Andrew Grande; Bharathi Jagadeesan; Brendan Killory; Mark Alberts; Inam Kureshi; Martin Ollenschleger; Ramachandra Tummala; Tapan Mehta

doi:10.3389/fneur.2022.990722

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

Front Neurol. 2022 Oct 25:13:990722. doi: 10.3389/fneur.2022.990722. eCollection 2022.

Affiliations

¹ Department of Neurology, University of Connecticut, Farmington, CT, United States.
² Department of Interventional Neuroradiology, Hartford Hospital, Hartford, CT, United States.
³ Department of Neurosurgery, Hartford Hospital, Hartford, CT, United States.
⁴ Department of Neurology, Radiology and Neurosurgery, University of Minnesota, Minneapolis, MN, United States.
⁵ Department of Neurology, Hartford Hospital, Hartford, CT, United States.

Abstract

Background: Trans-radial access (TRA) for MMA embolization has grown due to lower access 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.

Methods: We 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.

Results: A 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.

Conclusion: Trans-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 anterior circulation in elderly patients with difficult anatomy undergoing MMA embolization.

Keywords: embolization; middle meningeal artery; reverse angle guide catheter; subdural hematoma; trans-radial approach.