Individualized left transradial access for flow-diverter treatment in a patient with coexisting aberrant right subclavian and brachioradial arteries: A technical case report.

Abstract

Transradial approach (TRA) has been widely adopted in neuroendovascular procedures because of its lower incidence rates of access-site complications and improved patient comfort. However, anatomical variations of the upper extremity arteries and aortic arch can significantly affect catheter stability and procedural feasibility. We report a technical note describing the treatment of a cerebral aneurysm in a 38-year-old woman with concomitant aberrant right subclavian artery (ARSA) and right brachioradial artery (BRA). Diagnostic cerebral angiography performed through the right upper extremity revealed difficulty with selective catheterization of the anterior circulation due to these vascular anomalies. Based on these findings, left TRA was selected. Preprocedural assessment, including left upper extremity angiography, confirmed the feasibility of this approach. A flow-diverter stent was successfully deployed for a left internal carotid artery paraclinoid aneurysm using a Simmons-type guiding system through left transradial access, without procedural instability or major complications. In patients with multiple upper extremity arterial variations, including ARSA and BRA anomalies, right TRA may be technically challenging. Careful preprocedural evaluation of vascular anatomy and flexible selection of the access route are critical. Left TRA may serve as a safe and effective alternative when right-sided anatomical variants compromise catheter stability.