title: Alternative access for endovascular treatment of cerebrovascular diseases.
abstract: OBJECTIVE
  Data regarding the role of alternative access routes in neuro-endovascular interventions is limited. Our aim is to evaluate the safety and efficacy of alternative access in endovascular management of cerebrovascular diseases.
  
  
  METHODS
  29 patients who underwent endovascular interventions using alternative access techniques including transradial, transcervical with carotid cutdown and access through the superior ophthalmic vein (SOV) to manage various intracranial pathologies were retrospectively identified.
  
  
  RESULTS
  The mean patient age was 68 years. Mean follow-up was 6.6 months. The transradial approach was successfully used in the management of 3 aneurysms using the pipeline embolization device (PED), coiling and stent-assisted coiling, 2 arteriovenous malformations (AVMs) using Onyx embolization and 2 acute stroke interventions. This resulted in complete obliteration of 3 lesions and near complete occlusion (>90%) of 2 lesions and successful recanalization in the 2 patients with stroke. There were no access related complications. Transcervical access was successfully used to treat 6 aneurysms using the PED or coiling embolization without any complications. SOV cutdown followed by endovascular embolization was performed successfully in 16 patients harboring carotid-cavernous fistulas (CCFs) using Onyx embolization alone in 12 cases and Onyx with coiling in 4 patients. Complete obliteration was achieved in 14CCFs and near complete obliteration in 2CCFs. Complications occurred in 1 patient who had transient elevated intra-ocular pressure postoperatively.
  
  
  CONCLUSIONS
  When transfemoral access fails, alternative access routes using transradial, transcervical with carotid cutdown and access through the SOV can be safe and effective for managing various cerebrovascular lesions.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Badih
authors.initials: B
authors.lastname: Daou
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Barros
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. Electronic address: pascal.jabbour@jefferson.edu.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Alternative access; Superior ophthalmic vein; Transcervical; Transradial