Tumor Embolization Using a Small-Bore Guide via the Distal Radial Artery Approach: Report of Five Consecutive Cases.

Abstract

Objective: Cardiologists use the distal radial artery (dRA) approach in daily clinical practice. This method is gradually being applied in neuroendovascular treatment. However, limited studies have been reported concerning tumor embolization using small-bore guidance via dRA.

Case presentation: Five consecutive tumoral cases underwent endovascular embolization via the dRA approach. The right dRA was punctured, with manual confirmation of pulsation or under the guidance of ultrasonography, using a 22-G plastic cannulation needle. After the insertion of a 0.021-inch guidewire, a dilator of a 4-Fr sheath enlarged the puncture site. The 22-G plastic cannulation needle was replaced with an 18-G cannulation needle, and a 0.035 guidewire was inserted to introduce a small-bore guide. A TEMPO4 (Cordis, Miami Lakes, FL, USA; outer diameter: 1.35 mm) or a 3.6-Fr JB2 (Gadelius Medical, Tokyo, Japan; outer diameter: 1.2 mm) was used in 4 cases to convey embolization materials, whereas a 4-Fr, 16-cm sheath (Terumo, Tokyo, Japan; outer diameter: 2 mm) combined with a 4-Fr SY3 (Gadelius Medical; outer diameter: 1.4 mm) was used in 1 case. Trisacryl gelatin microspheres or n-butyl-2-cyanoacrylate were used as embolization materials. Hemostasis was achieved with PreludeSYNC DISTAL (Merit Medical, South Jordan, UT, USA), and the median time ± standard deviation of hemostasis was 2.00 ± 0.77 h. No complications occurred after embolization.

Conclusion: Tumor embolization using small-bore guide via the dRA approach was completed without any complications.