Reflected-wire technique for internal carotid artery catheterisation via the left radial approach in cerebral angiography

BACKGROUND: The aim of this study was to evaluate factors causing difficulty in internal carotid artery (ICA) access using the left transradial approach for diagnostic cerebral angiography. METHODS: This was a prospective, single-centre, analytical study (n = 32 enrolled, n = 31 analysed) with an indication for diagnostic cerebral angiography. Diagnostic angiography via left transradial access was performed in all cases. Factors influencing the bilateral ICA catheterisation were evaluated. RESULTS: Diagnostic angiography was successfully completed in all 31 analysed patients (100%). Successful RICA catheterisation was observed in 25 (80.6%) cases, and LICA catheterisation was observed in 77.43% (24/31) of cases. Reflecting the hydrophilic guidewire off the aortic root/valve to gain support and advance the catheter into the ICA was required in 17/24 (70.8%) of LICA and 9/25 (36%) of RICA cases to facilitate catheterisation. Positive correlation was observed between BCA-LCCA, left CCA-left subclavian artery angles and inability to cannulate LICA. A Type III arch was associated with an increased LICA cannulation time. The presence of a bovine aortic arch necessitated the use of the reflected-wire technique to cannulate the LICA. CONCLUSIONS: The reflected-wire technique can be used to facilitate ICA catheterisation via the left radial approach.