{
  "abstract": "Background Traditional neuroendovascular access is most commonly achieved through transfemoral or transradial approaches. The superficial temporal artery (STA) represents a rarely utilized alternative access site for procedures involving the head and neck. Superficial temporal artery retrograde (STAR) access may provide advantages including reduced access-site complications, avoidance of proximal vascular tortuosity, and potentially lower periprocedural embolic stroke risk due to avoidance of the aortic arch and great vessels. We present a large single-center experience utilizing STAR access across multiple neuroendovascular indications, expanding its indications beyond middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH).Methods We performed a retrospective review of consecutive cases from January 2024 through February 2026 in which the STA was used as the primary access site for endovascular intervention. Data collected included patient demographics, pathology treated, unilateral versus bilateral access attempts, procedural success, fluoroscopy time, and contrast utilization.Results A total of 112 patients were included with an average age of 71.1 years old. Of these, 64.3% (n=72) were male. STAR access was successfully achieved in 101 cases (90.2%), with 11 procedures requiring conversion to traditional access (transradial or transfemoral). Sixteen procedures involved bilateral access attempts, all for middle meningeal artery embolization for chronic subdural hematoma with an 81.3% success rate in STAR access and embolization. Treated pathologies included chronic subdural hematoma (96 cases), epistaxis (5 cases), tumor embolization (5 cases), dural arteriovenous fistula (4 cases), and diagnostic angiography (2 cases). No access-site or periprocedural complications were observed. Mean contrast utilization for successful STAR procedures was 42.7 mL with a mean fluoroscopy time of 10.6 minutes, which did not significantly differ from cases requiring conversion to traditional access (51.3 mL, p=0.379; 8.8 minutes, p=0.295). No patients required retreatment.Conclusion STAR access is a safe, feasible, and versatile technique for treating pathologies involving the carotid circulation. In this series, the technique demonstrated a high technical success rate without access-site complications and procedural metrics comparable to traditional access strategies in multiple pathologies beyond just MMA embolization for cSDH. Further studies are needed to identify risk factors for STAR access failure. The ability to perform these procedures without systemic heparinization may provide an additional advantage in patients with elevated hemorrhagic risk, particularly those undergoing treatment for chronic subdural hematoma or high-risk patients requiring anticoagulation. STAR access therefore represents an important addition to the neuroendovascular armamentarium.Disclosures J. Brazdzionis: None. C. Badger: None. T. Patchana: None. Y. Loh: None. Z. Tymchak: None. C. McDougall: None. S. Monteith: None. A.S. Patel: None.",
  "authors": [
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, WA"
      ],
      "name": "J Brazdzionis"
    },
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, WA"
      ],
      "name": "C Badger"
    },
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, WA"
      ],
      "name": "T Patchana"
    },
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, WA"
      ],
      "name": "Y Loh"
    },
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, WA"
      ],
      "name": "Z Tymchak"
    },
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, WA"
      ],
      "name": "C McDougall"
    },
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, WA"
      ],
      "name": "S Monteith"
    },
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, WA"
      ],
      "name": "AS Patel"
    }
  ],
  "title": "E-084 Superficial temporal artery retrograde access (STAR): expanding the neuroendovascular armamentarium",
  "uid": "40909c43-cf17-5935-b8bd-0434a1e39304"
}