Brachial Artery Approach for Endovascular Treatment of Posterior Circulation Intracranial Vascular Disease: Technique and Application in 5 Cases

Although the transbrachial artery approach has been well described as an alternative for percutaneous coronary interventions and diagnostic cerebral arteriography, little has been reported regarding the use of this technique for therapeutic neuroendovascular procedures. We highlight the technical applications of this technique during 5 procedures. Three women (age 68, 69, and 83 years) and 1 man (age 79 years) were treated using brachial artery access. Two of the women with complex posterior circulation aneurysms were treated with stent-assisted coil embolization. The third woman presented with a symptomatic occlusion of the basilar artery and underwent intra-arterial thrombolysis and angioplasty, followed at a later date by a second intra-arterial thrombolysis procedure. The male patient presented with recurrent, intractable posterior circulation ischemic events and underwent balloon angioplasty and stenting of a high-grade stenosis of the right vertebral artery. All patients had failed treatment via a transfemoral route and demonstrated significant thoracoaortic and/or iliofemoral tortuosity. Appropriate intracranial vascular access was achieved in all patients, and there were no intraprocedural complications. We conclude that a transbrachial approach may be successfully used for a variety of therapeutic neuroendovascular interventions when a transfemoral route is not available.