Transradial Approach for Deployment of a Flow Diverter for an Intracranial Aneurysm in a Patient with a Type-3 Aortic Arch

Abstract

Background—Flow diversion with the Pipeline embolization device (PED) is an effective treatment for
giant and wide-neck intracranial aneurysms, but the standard transfemoral approach may not be feasible in
patients with Type-3 aortic arches.
Case Report—An 84-year-old woman presented with a right internal carotid artery (ICA) giant aneurysm
and a Type-3 aortic arch, necessitating a transradial approach for access to the right common carotid artery.
A triaxial catheter system made for a stable platform for the deployment of two telescoping PEDs to treat
the patient's right ICA giant aneurysm. The procedure was technically successful, and there were no immediate complications.
Conclusion—The transradial approach allows for carotid access in patients with challenging aortic
arches, and this report demonstrates its effectiveness for deployment of flow diverters, especially with a
triaxial catheter system. The peripheral access point facilitates hemostasis, which is of great importance in
patients on antiplatelet medications to prevent thrombotic complications of flow diverters.