Transradial approach for vertebral artery stenting: Technical case report

We report the technique of transradial vertebral artery stenting for two patients in whom severe supra-aortic ectasia prevented ready access to the right vertebral artery origin. An Allen test was performed to verify ulnar artery collateral flow in the hand. After the administration of local anesthesia, a 6-French sheath was introduced into the radial artery. To allay induced spasm, a mixture of heparin (5000 IU/ml), verapamil (2.5 mg), nitroglycerine (400 μg/ml, 0.25 ml), and lidocaine (2%, 1.0 ml) was infused through the introducer sheath. A microguidewire was positioned across the vertebral artery lesion, followed by placement of a balloon-expandable stent. Postdeployment angiography revealed improved vertebrobasilar system flow. There were no complications related to the radial artery. The patients tolerated the procedure without difficulty and were immediately ambulatory. This novel approach should be considered for endovascular procedures for which access to the vertebral artery origin via the femoral approach is limited.