Transradial or Transulnar Long Sheath Access to the Brachial Artery Allows for Neuroendovascular Procedures in Patients with Radial or Ulnar Artery Occlusion

Transradial access is an important tool for many neuroendovascular procedures. Occlusion of the radial or ulnar artery is not uncommon after transradial or transulnar access, and can present a challenge for patients requiring repeat angiography. Between March 2022 and June 2023, patients undergoing a transradial or transulnar angiogram who were found to have a radial artery occlusion (RAO) or ulnar artery occlusion were identified. Repeat catheterization of the occluded artery was attempted using a 21-gauge single wall puncture needle and a 0.021-inch wire to traverse the occlusion and insert a 23 cm sheath into the brachial artery. A total of 25 patients undergoing 26 angiograms during the study period were found to have a RAO or ulnar artery occlusion. Successful repeat catheterization of the occluded artery was achieved in 21 of 26 cases (80.7%). Outer diameter sheath size ranged from 5 Fr (0.0655 inches) to 8 Fr (0.1048 inches). No access complications were encountered. Number of prior angiograms, time since prior angiogram, and prior angiogram procedure time were associated with lower likelihood of successful access. Transradial or transulnar neuroangiography through an occluded radial or ulnar artery is safe and feasible by traversing the occlusion into the brachial artery with a 23cm sheath. Repeat catheterization is most successful in patients with an arterial occlusion less than 6 months old. This technique is important in patients who have limited options for arterial access, avoiding access site complications inherent in transfemoral access, or in patients who specifically require radial or ulnar artery access.