Neurointervention.  2022 Jul;17(2):100-105. 10.5469/neuroint.2022.00010.

Transradial Approach for Thoracolumbar Spinal Angiography and Tumor Embolization: Feasibility and Technical Considerations

• Caton MT
• Smith ER
• Baker A
• Dowd CF
• Higashida RT

• KMID: 2531565
• DOI: http://doi.org/10.5469/neuroint.2022.00010

Abstract

The transradial approach (TRA) is an effective and safe alternative to transfemoral access for diagnostic neuroangiography and craniocervical interventions. While the technical aspects of supraclavicular intervention are well-described, there are little data on the TRA for thoracolumbar angiography and intervention. The authors describe the feasibility of the TRA for preoperative thoracic tumor embolization, emphasizing technique, device selection, navigation, and catheterization of thoracolumbar segmental arteries. This approach extends the benefits of TRA to spinal interventional neuroradiology.

Keyword

Endovascular procedures; Spinal cord vascular diseases; Radial artery; Angiography, digital subtraction; Transradial approach

Figure

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  Fig. 1. (A) Digital subtraction angiography selective injection of the left T3 segmental artery through the diagnostic catheter demonstrates cranial angulation and hypervascular tumor blush (black straight arrows) involving the T3 vertebral body and adjacent soft tissues. (B) Post-embolization selective injection through the microcatheter (white arrowhead) shows significantly reduced tumor vascularity with intra-arterial coil placement (curved black arrow). The course of the Simmons-type catheter from the trans-radial approach is demonstrated by curved white arrows.

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  Fig. 2. TRA using long (130 cm) Penumbra Vert Catheter (A, white curved arrows). DSA roadmap (B) shows near parallel orientation of the left L4 segmental artery origin and the catheter tip angle (white dotted arrows). Over a glidewire, the catheter could easily select the segmental artery (C, tumor blush=black arrows), facilitating successful repeat embolization using PVA particles (D, post-embolization, diminished tumor blush=white arrows). TRA, transradial approach; DSA, digital subtraction angiography; PVA, polyvinyl alcohol.

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  Fig. 3. Summary of “inverse” catheter geometry and strategies for spinal radicular artery selection with 4 common aortic catheter types. The Simmons-type catheter (A) was used to access the left T3 segmental artery and may be favorable for many upper and mid-thoracic lesions. The C2 (“Cobra”) catheter (B) has a cranially-directed tip which may be advantageous for upper thoracic segmental arteries. The Vertebral catheter shape (C) affords less support in the aorta lumen but may be optimal for caudally-directed lumbar segmental arteries. The Mikaelsson catheter (D) offers the most “neutral” tip-angle and would therefore function similarly from transradial and transfemoral approaches, providing the greatest stability at mid-thoracic levels.

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