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British Journal of Radiology (2004) 77, 831-838
© 2004 British Institute of Radiology
doi: 10.1259/bjr/89933527
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Routine transradial access for conventional cerebral angiography: a single operator's experience of its feasibility and safety

D H Lee, MD 1 J H Ahn, MD 1 S S Jeong, MD 2 K S Eo, RT 1 and M S Park, MD 1

Departments of 1 Radiology and 2 Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Sacheon-myon, Gangneung-si, Gangwon-do, 210-711, Korea



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  		Figure 1. A method of folding the Simmons catheter curve using the aortic arch by the looping method (Method 1). (a) The tip of the catheter is negotiated into the descending thoracic aorta with the aid of the distal curve of the catheter and a J-tipped guide wire. (b) The main loop is formed by pushing the catheter into the ascending aortic arch while the guide wire is within the catheter with the tip at the primary curve of the catheter. (c) Now the curve is formed within the ascending aorta ready to select the supra-aortic branches.

 



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  		Figure 2. A method of folding the Simmons catheter curve within the ascending aorta (Method 2). In some patients with very tortuous and wide aortic arch, Method 1 cannot be utilized because advancing the guide wire to the descending thoracic aorta is impossible. In such cases, the reversed curve of the Simmons catheter can be made within the ascending aorta. (a) A guide wire loop is made within the ascending aorta with the top of the loop abutting the cusps of the aortic valve. (b) A catheter is then advanced over the loop of the guide wire. The course of the catheter and wire is blurred due to the cardiac motion. (c) Finally the catheter curve is obtained.

 



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  		Figure 3. The technique of selective catheterization of the supra-aortic branches. (a) The left subclavian artery is selected first in most cases. The origin of the left vertebral artery is also evaluated. Selective catheterization of the left vertebral artery can be done with the aid of a guide wire. (b) Then the left common carotid artery is selected. (c) If selection of the left internal carotid artery is required, we can easily advance the catheter over a guide wire into the internal carotid artery. In some patients with a very acute branching pattern, use of a stiff guide can be helpful. Once the catheter begins to advance, we can select the internal carotid artery with ease (not shown). (d) Selection of the right common carotid artery is usually not challenging. It is just necessary to pull the catheter gently with its tip within the common carotid artery. The catheter can easily be advanced over the guide wire if selection of the ipsilateral internal carotid artery is necessary. (e) After completion of right internal carotid arteriography, the catheter is pulled back, thereby unfolding the reversed curve. We can select right vertebral artery in this position simply by using a guide wire.

 




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