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Transcervical access via direct neck exposure for neurointerventional procedures in the hybrid angiosuite

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

A complicated course of the femoral route for neurointervention can prevent approaching the target. Thus, we determined whether transcervical access in the hybrid angiosuite is applicable and beneficial in real practice.

Methods

From January 2014 to March 2017, this approach was used in 17 of 453 (3.75%) cases: 11 cerebral aneurysms (4 ruptured, 7 unruptured), 4 acute occlusions of the large cerebral artery, 1 proximal internal carotid artery (ICA) stenosis, and 1 direct carotid cavernous fistula (CCF).

Results

All patients were elderly (mean age, 78.1 years). The main cause was severe tortuosity of the supra-aortic course or the supra-aortic and infra-aortic courses (eight and five cases, respectively), orifice disturbance (three cases), and femoral occlusion (one case). Through neck dissection, 6–8Fr guiding catheters were placed via subcutaneous tunneling to enhance device stability and support. All cerebral aneurysms were embolized (eight complete and three neck remnants) using the combination of several additional devices. Mechanical stent retrieval with an 8Fr balloon guiding catheter was successfully achieved in a few runs (mean, 2 times; range, 1–3) within the proper time window (mean skin to puncture, 17 ± 4 min; puncture to recanalization, 25 ± 4 min). Each stent was satisfactorily deployed in the proximal ICA and direct CCF without catheter kick-back. All puncture sites were closed through direct suturing without complications.

Conclusions

In the hybrid angiosuite, transcervical access via direct neck exposure is feasible in terms of device profile and support when the femoral route has an unfavorable anatomy.

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Authors and Affiliations

  1. Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 134-701, Republic of Korea

    Jong Young Lee, Jong-Hwa Park, Hong Jun Jeon & Byung Moon Cho

  2. Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 134-701, Republic of Korea

    Dae Young Yoon

  3. Department of Neurosurgery, Gangwon National University Hospital, Gangwon National University College of Medicine, 156, Baengnyeong-ro, Chuncheon-si, Gangwon-do, 200-722, Republic of Korea

    Seoung Woo Park

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  1. Jong Young Lee
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  2. Jong-Hwa Park
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Correspondence to Hong Jun Jeon.

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Funding

This study was funded by the Hallym University Research Fund 2016 (HURF-2016-33).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Lee, J.Y., Park, JH., Jeon, H.J. et al. Transcervical access via direct neck exposure for neurointerventional procedures in the hybrid angiosuite. Neuroradiology 60, 565–573 (2018). https://doi.org/10.1007/s00234-018-1994-4

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  • DOI: https://doi.org/10.1007/s00234-018-1994-4

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