Anatomic Snuffbox (Distal Radial Artery) and Radial Artery Access for Treatment of Intracranial Aneurysms with FDA-Approved Flow Diverters

Frontal roadmap image reveals very straight anatomy of the innominate, right subclavian, and common carotid arteries (A). Catheter navigation from a right transradial access is not easy, given that the vector force will push the catheter into the right innominate artery (A, arrow). Frontal roadmap image shows a fairly horizontal course of the right subclavian artery and a straight continuation of the right innominate artery into the right CCA (B). Here, the vector force will push a right transradially navigated catheter into the innominate artery (B, arrow), making catheterization of the right intracranial vasculature difficult. Frontal roadmap image demonstrates a medially directed origin of the left CCA from the aortic arch. This makes access from a right radial approach difficult because the catheter will be pushed into the ascending aorta (C, arrow). Additional tortuosity along the course of the left CCA increases the difficulty of the approach. Frontal roadmap image shows an aberrant origin of the right subclavian artery (D). Navigation of a right transradial catheter is difficult, given that the catheter is directed toward the descending aorta. Larger catheter systems will not have sufficient stability, and catheter herniation into the descending aorta is to be expected.