Transradial approach for vertebral artery stenting: Technical case report

OBJECTIVE: We report the technique of transradial vertebral artery stenting for two patients in whom severe supra-aortic ectasia prevented ready acces s to the right vertebral artery origin. METHODS: An Alien test was performed to verify ulnar artery collateral flow in the hand. After the administration of local anesthesia, a 6-French shea th:was introduced into the radial artery. To allay induced spasm, a mixture of heparin (5000 IU/ml), verapamil (2.5 mg), nitroglycerine (400 mu g/ml, 0.25 mi), and lidocaine (2%, 1.0 mi) was infused through the introducer she ath. A microguidewire was positioned across the vertebral artery lesion, fo llowed by placement of a balloon-expandable stent. RESULTS: Postdeployment angiography revealed improved vertebrobasilar syste m flow. There were no complications related to the radial artery. The patie nts tolerated the procedure without difficulty and were immediately ambulat ory. CONCLUSION: This novel approach should be considered for endovascular proce dures for which access to the vertebral artery origin via the femoral appro ach is limited.