Use of the Simmons guiding sheath via left transradial access as a feasible strategy for neurointerventions in patients with an aberrant right subclavian artery

We read with interest the paper ‘Transradial flow diversion with an aberrant right subclavian artery’ by Bram et al.1 The authors presented the case of a patient with an aberrant right subclavian artery (ARSA) who underwent flow diversion for a small left internal carotid artery (ICA) aneurysm via a right transradial access (TRA). Under general anesthesia, a 6F Slender sheath (Terumo, Tokyo, Japan) was introduced via the right TRA, and a Simmons-2 catheter was delivered into the right subclavian artery. Despite attempts to reshape the Simmons-2 curve, the procedure failed because it prolapsed into the descending aorta. The patient was found to have an ARSA. Subsequently, a Simmons-1 catheter was easily navigated from the ARSA ostium toward the aortic valve owing to its shape. After shaping a guidewire by bouncing it off the aortic valve, the Simmons-1 catheter was then exchanged for the Simmons-2 catheter over the...

Source: Journal of NeuroInterventional Surgery - October 12, 2023 Category: Neurosurgery Authors: Hanaoka, Y., Inomata, Y., Koyama, J.-i., Nakamura, T., Kitamura, S., Yamazaki, D., Horiuchi, T. Tags: Letter Source Type: research