Ransom, R Chase

Background There has been growing interest in transradial procedures over the past decade due to substantial reductions in access site complications as well as improved patient recovery. While several radial-specific neurovascular catheters have come to market, all catheters that are compatible with a 7Fr sheath have small inner diameters (IDs) (0.079″–0.082″), which can limit use of modern intermediate catheters. while larger-ID catheters cannot be used with a radial sheath resulting in complications related to radial artery spasm and entrapment. We report our results using a novel 7Fr-sheath-compatible radial guide catheter with an 0.087″ ID (Piraeus 7Fr 87 NeuGlide catheter) for neurovascular procedures. Methods This is a single center retrospective case series of patients undergoing transarterial transradial neuroendovascular procedures using the Piraeus 7Fr 87 NeuGlide catheter. The primary outcome was delivery of the catheter to the target vessel and successful completion of the procedure without the need to convert to femoral access or an alternative guide. Descriptive statistics are reported. Results Forty patients were included. The most common procedure was middle meningeal artery embolization followed by aneurysm embolization. And 97.5% of procedures were completed successfully without conversion to femoral access; 75% were completed without the need of an intermediate guide catheter. One procedure required conversion to femoral access. There were no access site or neurological complications. Conclusion The Piraeus 7Fr 87 NeuGlide catheter is both safe and effective for neurovascular procedures. The larger ID and 7Fr compatible outer diameter allows for the use of standard 5Fr and 6Fr intermediate/aspiration catheters.

Background Achieving functional repair after peripheral nerve injury (PNI) remains problematic despite considerable advances in surgical technique. Therein, questions lie regarding the variable capacity of peripheral nerves to regenerate based on environmental influence. In-depth analyses of multiple therapeutic strategies have ensued to overcome these natural obstacles. Of these candidate therapies, electrical stimulation has emerged a frontrunner. Extensive animal studies have reported the ability of brief intraoperative electrical stimulation (BES) to enhance functional regeneration after PNI. Despite these reports, the exact mechanisms by which BES enhances regeneration and its effects on long nerve lesions are largely unknown. Indeed, clinical translation of this seemingly simple therapeutic has not been so simple, but a few studies performed in humans have yielded highly encouraging results. Objective We aimed to help bridge this translational gap by presenting the latest clinical trials on electrical stimulation for PNIs in combination with relevant etiologies, treatments and nonclinical findings. Methods To do so, a systematic search was performed on PubMed, IEEE, and Web of Science databases up to February 2020 using keywords significant to our study. References of each manuscript were screened for additional manuscripts of relevance to our study. Results We found multiple BES clinical studies reporting enhanced functional recovery or increased nerve regeneration. Although improved outcomes were reported, high variability after BES is seen between and within species likely due to injury severity, location and timeline along with other factors. Conclusion Further clinical studies and introduction of novel delivery platforms are vital to uncover the true regenerative potential of electrical stimulationtherapy.