{
  "abstract": "Introduction Venous sinus stenting (VSS) has emerged as an endovascular treatment option for idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT) secondary to venous sinus stenosis. While technical approaches vary in access site, base catheter selection, and stent platform, most reported series utilize 8- or 9-French guide catheter systems, typically via transfemoral access, and, more recently, upper extremity venous approaches. Larger-caliber systems may increase the risk of access site complications and limit distal navigability. We hypothesized that lower-profile, radial artery-specific base catheter systems delivered via upper extremity venous access would enable safe, effective intracranial VSS while improving access efficiency and maintaining high technical success rates.Methods Retrospective review of prospectively maintained procedural databases at 2 independent institutions identified VSS procedures using 6- or 7-French radial specific catheters via either upper or lower extremity approaches. Demographic, procedural, and outcome data—including technical success, complication rates, and clinical outcomes—were collected. Continuous variables were analyzed using the Mann-Whitney U test, and categorical variables using Fisher’s exact test.Results Forty-seven patients underwent VSS using 6- or 7-French radial artery-specific base catheter systems. Mean age was 37±12 years, and 89% were female. Indications included idiopathic intracranial hypertension (81%) and isolated pulsatile tinnitus (17%). Technical success was achieved in all cases, with 54 stents deployed across 47 patients with no access-related or intracranial complications observed. Primary upper extremity access was attempted in 41 procedures (87%) cases with 2 instances of cross over to lower extremity access; 6 cases (13%) were performed via primary lower extremity access. The base catheter was able to be advanced into the intracranial venous sinuses in all cases with 70% of stenotic lesions successfully crossed, permitting direct stent unsheathing across the target lesion. Six-French systems were used in 47% of cases and 7-French systems in 53%. Comparison of upper versus lower extremity access demonstrated no significant differences in demographic characteristics, procedural variables, technical success, intracranial delivery, lesion crossing, or presence of operative complication (all p>0.05).Conclusion Use of lower-profile, radial artery-specific catheter systems for venous sinus stenting is safe, effective, and technically feasible. Radial catheters demonstrate high rates of successful intracranial access, ability to cross stenotic lesions, and stent delivery/deployment with no observed procedural complications. Upper extremity venous access enables reliable delivery of these systems without compromise in technical performance compared to lower extremity approaches. These findings support a paradigm shift toward lower-profile access strategies for VSS. Future studies should directly compare 6- and 7-French systems with conventional 8- and 9-French platforms to evaluate differences in technical efficiency, access-related complications, procedural time, and cost.Disclosures J. Sone: None. N. Lam: 1; C; The Segal Family Foundation provides grant support for the Segal Family Internship in Cerebrovascular Medicine. Z. Hoglund: None. K. Scott: None. V. Srinivasan: None. W. Ares: 1; C; The Segal Family Foundation provides grant support for the Segal Family Internship in Cerebrovascular Medicine.Abstract E-236 Table 1Descriptive representation of radial artery-specific base catheters utilizedRadial Artery-Specific Base Catheter ModelVSS cases (N=47)Penumbra BMX81 7Fr18 (38%)Q’Apel Zebra13 (28%)6Fr12 (26%)7Fr1 (2%)Medtronic RIST10 (21%)6Fr9 (19%)7Fr1 (2%)Q’Apel Armadillo 7Fr5 (11%)Wallaby Esperance 6Fr1 (2%)",
  "authors": [
    {
      "affiliations": [
        "Department of Neurological Surgery, University of Chicago, Chicago, IL"
      ],
      "name": "J Sone"
    },
    {
      "affiliations": [
        "Northwestern University, Evanston, IL"
      ],
      "name": "N Lam"
    },
    {
      "affiliations": [
        "Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "Z Hoglund"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "K Scott"
    },
    {
      "affiliations": [
        "Neurological Surgery, NorthShore University HealthSystem and Edward-Elmhurst Health, Naperville, IL"
      ],
      "name": "DM Heiferman"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "V Srinivasan"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Endeavor Health, Evanston, IL"
      ],
      "name": "W Ares"
    }
  ],
  "title": "E-236 Venous sinus stenting via upper extremity access with radial access catheters: a multicenter case series of safety and efficacy",
  "uid": "b764bad3-48d2-5665-a079-bb6f17c3cf37"
}