CTA-Based Patient-Tailored Femoral or Radial Frontline Access Reduces the Rate of Catheterization Failure in Chronic Subdural Hematoma Embolization

Illustrative examples of challenging and failed catheterization cases. Manually-segmented surface-rendering 3D reconstructions of CTAs of aortic arches of patients included during periods 1 (A–C) and 2 (D–F). A, Anterior view of a case of failed right carotid catheterization by femoral access due to a proximal kinking of the right common carotid artery (right arrow) in a type III aortic arch. B, Anterior view in a case of failed left carotid catheterization by femoral access due to a bovine arch configuration (right arrow), which, in retrospect, would have been an ideal candidate for radial access. C, Anterior view in a case of failed left carotid catheterization by femoral access converted secondarily to transradial catheterization in relation to a bovine arch (right arrow). D, Posterior view of a case of failed right carotid catheterization by a frontline femoral access most probably due to the angulation between the brachiocephalic trunk and the aortic arch, with subsequent successful radial access conversion. E, Anterior view of a bilateral CSDH in which a frontline radial access was chosen. Following right CSDH embolization by the transradial approach, failure to navigate the left carotid artery led to radial-to-femoral access conversion and left-sided successful embolization. F, Anterior view in a case of failed catheterization of the left carotid artery from a frontline femoral access after which the procedure was aborted.