Radial access with the Piraeus 7Fr 87 NeuGlide catheter: A single center study of 40 patients

Abstract

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.

Introduction

There has been growing interest in transradial intervention for neuroendovascular procedures due to lower access complication rates, improved patient recovery as well as physician preference. Over the past several years, several innovative radial guide catheters have come to market, including but not limited to the RIST, Armadillo, BMX81, and Zoom RDL. Other popular catheters which are used transradial, but are designed for femoral use include the Ballast and the Benchmark. Despite the growing interest in radial procedures, a majority of neuroendovascular procedures are still performed transfemoral. This lack of widespread adoption is driven by the limitations of currently available radial devices. Specifically, nearly every available 7Fr sheath compatible radial catheter has an inner diameter (ID) in the 0.079″ to 0.082″ range, which precludes the use of standard 6Fr intracranial/intermediate and aspiration catheters which are popular for both hemorrhagic and ischemic procedures (i.e. Sofia Plus, Zoom 71, etc). Meanwhile, general-purpose and radial-specific guide sheaths that have IDs ≥0.087″ are not compatible with 7Fr short sheaths which can result in high rates of spasm, catheter retention, challenges with accessing the radial artery and issues with trackability. In addition, the IDs of radial systems can be limited enough that “roadmapping” with contrast injected around a 5Fr intermediate catheter is generally restricted. Until recently, therefore, the specifications of transradial access systems limited the full range of procedural methods that could be used while maintaining 7Fr short sheath access.

As of January 2025, the Piraeus 7Fr 87 NeuGlide catheter has been approved by the Food and Drug Administration for the introduction of interventional devices into the peripheral, coronary, and neurovasculature. We report the results of a single center case series of the use of the 7Fr 87 NeuGlide catheter for transradial procedures.

Methods

Patient selection

Following Institutional Review Board approval, we retrospectively identified all patients who underwent transarterial transradial neuroendovascular procedures using the 7Fr 87 NeuGlide catheter between January and March 2025 at our institution. The device was used at the discretion of four operators at our institution. Inclusion criteria were the following: (1) age ≥18 years old, (2) radial artery diameter ≥1.7 mm (allowing for insertion of a 7Fr radial sheath), (3) underwent a neurovascular procedure, and (4) transradial access using the 7Fr 87 NeuGlide catheter. All patients who were included provided informed consent for participation in retrospective studies. Patients who underwent transfemoral procedures or transvenous procedures with the 7Fr 87 NeuGlide catheter were excluded from this study.

Baseline data collected included age, gender, pathology treated (i.e. aneurysm, arteriovenous malformation, arteriovenous fistula, stroke, chronic subdural hematoma, intracranial atherosclerotic disease, ENT (Ear, Nose, and Throat) hemorrhagic, tumors, and carotid stenosis), type of procedure performed (i.e. aneurysm repair, thrombectomy, liquid embolic including Onyx or polyvinyl alcohol, carotid revascularization, and intracranial revascularization), access side and site, radial artery diameter, sheath type and length and use of intermediate catheter.

Endpoints

All outcomes were assessed with retrospective chart review. The primary outcomes were delivery of the 7Fr 87 NeuGlide catheter to the target vessel and successful completion of the procedure without complications. Safety outcomes included radial artery spasm, radial artery perforation, catheter entrapment, arterial dissection and ischemic, hemorrhagic, or other complications related to the neuroendovascular procedure. In addition, during each procedure involving a 5Fr intermediate catheter, the physician attempted to roadmap by injecting contrast around the 5Fr intermediate catheter. As a part of this, an intraprocedural outcome was assessed: roadmap image quality when injecting around 5Fr intracranial access catheters (assessed as 1–5 on a Likert scale with 1 being poor and 5 being excellent and 3 being acceptable).

Description of NeuGlide access system

The NeuGlide is a 7 French 087″ ID interventional guide catheter which currently comes in 100 cm length with 21 cm of hydrophilic coating. The outer diameter of the device is 7Fr making it compatible with the two most commonly used slim 7Fr radial sheaths: the Terumo 7Fr Glidesheath Slender and the 7Fr Prelude Ideal. The use of a patent pending novel construction for the device has allowed for the 7Fr 87 NeuGlide catheter to dramatically reduce catheter wall thickness to achieve 7Fr short sheath compatibility while providing a full 0.087″ working lumen.

This novel construction has been optimized for trackability, support, and kink resistance, all of which are features vital for successful in transradial delivery to the neurovasculature. Over 150 physician in vitro evaluations with 176 device design iterations were completed in development to achieve the optimal product design to navigate the pathway to the cervical internal carotid or vertebral artery. The catheter has been designed to allow for the delivery of most commonly used 6Fr aspiration catheters, including the Sofia Plus and Zoom 71, and is compatible with every 5Fr delivery catheter.

Procedure technique

The 7Fr 87 NeuGlide catheter procedural technique is similar to that previously published regarding use of the RIST or BMX81.^1,2 Ultrasound guided access of the radial artery was used in every case. In general, a 7Fr radial-specific short sheath (i.e. Prelude Ideal or GlideSheath Slender) was used for every case. Following insertion of the sheath, 5 mg of verapamil were injected into the sheath and flushed with 10cc of saline. The sheath was not connected to flush. 6000U of heparin were administered transvenously. The 7Fr 87 NeuGlide catheter was inserted into the sheath over a 5Fr 125 cm Simmons 2 catheter for carotid procedures or a 125 cm vertebral catheter for vertebral artery procedures. Catheterization of carotid and vertebral vessels were performed with the select catheters and the 7Fr 87 NeuGlide catheter was advanced to the target vessel over a stiff angled glide wire. In general, it was not required to advance the Simmons or vertebral catheter beyond the ostium of the common carotid or vertebral artery to delivery the 7Fr 87 NeuGlide catheter more distally. Following this, the desired intervention was performed. Once the procedure was completed, the catheter and sheath were removed and a TR band was applied to the radial artery. Patients underwent post operative assessment in the inpatient setting for at least 24 hours postprocedure or had a standard follow-up nurse call at 24 hours to report any complications. All patients had follow up beyond 1 week as well.

Statistical analysis

No hypothesis testing was performed. We report continuous variables as mean and standard deviation and categorical variables as percent. All statistics were performed using Microsoft Excel or ChatGPT.

Results

Baseline characteristics

A total of 40 procedures in 40 patients were performed. Mean age was 63.5 years (standard deviation: 17.8). Twenty-three patients were male and 17 patients were female. The mean radial artery diameter was 2.1 mm. And 55% of patients had a radial artery diameter >2 mm. All cases were performed via the right radial artery. A majority of cases were performed using the 7Fr Prelude Ideal Short Sheath (16 cm) and the remainder using the GlideSheath Slender Short Sheath. The most common procedure was aneurysm embolization (42.5%) followed by middle meningeal artery embolization (17.5%) and then ischemic stroke (15.0%). Table 1 summarizes baseline patient data.

Table 1.

Summary of data.

Variable	Outcome; n (%)
Sex
Male	23 (57.5)
Female	17 (42.5)
Mean age (SD)	63.5 (17.8)
Pathology treated
Aneurysm	17 (42.5)
AVM	4 (10.0)
dAVF	2 (5.0)
Stroke	6 (15.0)
cSDH	7 (17.5)
ICAD	0 (0.0)
Hemorrhage	0 (0.0)
Tumor	3 (7.5)
Carotid stenosis	1 (2.5)
Procedure performed
Aneurysm repair	17 (42.5)
Mechanical thrombectomy	6 (15.0)
Liquid embolic	16 (40.0)
Carotid revascularization	1 (2.5)
Access side
Right	40 (100.0)
Left	0 (0.0)
Access site
Proximal radial	40 (100.0)
Distal radial	0 (0.0)
Mean radial artery diameter in mm(SD)	2.1 (0.2)
Sheath type
16 cm Terumo	4 (10.0)
16 cm Prelude idea	36 (90.0)
Arch type
1	16 (40.0)
2	15 (37.5)
3	9 (22.5)
Use of intermediate catheter
Yes	10 (25.0)
No	30 (75.0)
Type of intermediate
5Fr Sofia	6 (15.0)
6Fr Sofia	4 (10.0)
Other	0 (0.0)
Target vessel
Right vertebral	10 (25.0)
Right ECA	12 (30.0)
Right ICA	14 (35.0)
Left ECA	6 (15.0)
Left ICA	11 (27.5)
Case success
Yes	39 (97.5)
No, conversion to different guide catheter	0 (0.0)
No, femoral conversion	1 (2.5)
No, intervention aborted	0 (0.0)
Access site complications
None	40 (100.0)
Minor	0 (0.0)
Major	0 (0.0)
Other procedural-related complications
None	40 (100.0)
Dissection	0 (0.0)
Perforation	0 (0.0)
Stroke	0 (0.0)

AVM: arteriovenous malformation; cSDH: chronic subdural hematoma; dAVF: dural arteriovenous fistula; ECA: external carotid artery; ICA: internal carotid artery; ICAD: intracranial atherosclerotic disease.

Procedural outcomes

Our primary outcome of delivery of the 7Fr 87 NeuGlide catheter to the target vessel was reached in 97.5% (39/40) of patients. The target vessel was reached in all patients, however in one case we had to convert a transradial stroke intervention to transfemoral (but were able to use the same 7Fr 87 NeuGlide catheter transfemoral) due to catheter kickback in a hostile aortic arch. The target vessel was the vertebral artery in 25% of cases and the internal carotid artery (ICA) in 62.5% of cases; the 7Fr 87 NeuGlide catheter was successfully navigated to the distal cervical or petrous segment in all cases where the ICA was to be catheterized.

Our other primary outcome of successful completion of the procedure without complications was reached in 97.5% (39/40) of patients. Right-sided carotid interventions were performed in 35.0% of cases and left-sided interventions in 27.5%. Only one procedure required conversion to femoral access, however, this procedure was successfully completed with the same 7Fr 87 NeuGlide catheter used to start the procedure. There were no instances of procedure limiting spasm, dissection, stroke, hemorrhagic complications, or catheter entrapment. Roadmap quality when injecting around a 5Fr access catheter was graded as a 5 on the Likert scale in 100% (40/40) of cases. Three illustrative cases are shown in the Figures 1–3 (Figure 1: 86-year-old female with a right M1 occlusion on CT angiogram (CTA); Figure 2: Woven EndoBridge Device Placement through NeuGlide in a Young Female; and Figure 3: Stroke Thrombectomy in a Nonagenearian). Table 1 summarizes outcomes and complications.

Figure 1.

A 86-year-old female with a right M1 occlusion on CTA. Note the tortuosity of the brachiocephalic artery and right common carotid artery ((A) and (B)). (C) Right ICA angiogram with the NeuGlide at the distal cervical right ICA (arrow) shows the high grade stenosis of the right M1. (D) We then advanced a Balt Carrier across the lesion and left it in position for 5 minutes (arrow). (E) Final angiogram shows recanalization of the occlusion with improvement of flow and the stenosis. CTA: CT angiogram; ICA: internal carotid artery.

Figure 3.

Stroke thrombectomy in a nonagenearian. (A) CTA shows a very challenging aortic arch, including a tough take-off of the left common carotid artery. (B) Left CCA angiogram shows marked tortuosity of the left ICA. (C) Left ICA angiogram shows the catheter across the first bend of the left ICA with no spasm. The left MCA occlusion is evident. (D) Following two passes with Sofia Plus catheter, the left MCA occlusion was recanalized. CCA: common carotid artery; CTA: CT angiogram; ICA: internal carotid artery; MCA: middle cerebral artery.

Figure 2.

Woven EndoBridge device placement through NeuGlide in a young female. (A) CTA shows a type 1 aortic arch. (B) X-ray image showing the NeuGlide crossing the aortic arch into the left ICA. (C) Lateral ICA angiogram showing the NeuGlide in the distal left cervical ICA (arrow). (D) Control angiogram through the NeuGlide with a 5Fr Sofia through it showing the WEB device well positioned in the aneurysm. CTA: CT angiogram; ICA: internal carotid artery; WEB: Woven EndoBridge.

Discussion

Our study of 40 consecutive patients undergoing transradial neurovascular interventions using the 7Fr 87 NeuGlide catheter demonstrates safety and technical feasibility of radial access and guiding to the neurovasculature. The device was effective for radial access, with a case completion rate without femoral conversion of 97.5% and safe, with no access-related complications in any procedure. Except for this conversion, the catheter was able to be successfully tracked to the target vessels from the radial artery in every case.

These findings have several important implications. First, the 7Fr 87 NeuGlide catheter could be used for a wide range of neurointerventional procedures, including the more challenging left sided procedures. Using the first available 0.087″ ID device to be delivered transradial through commonly used thin-walled radial sheaths, the neurointerventionalist is able to perform stroke interventions requiring up to 6Fr aspiration catheters as well as roadmapping around a 5Fr catheter during complex procedures, such as intracranial embolization, where intraprocedural visualization would be required.

A number of radial catheters are currently available on the market that have addressed several of the unmet clinical needs in transradial neurointervention. However, the limitations of these devices detailed above have slowed adoption of transradial access in neurointervention. There are several important features to any transradial procedure that current catheters offer: trackability and stability. Physicians have addressed challenges with tracking and stability (in both transradial and transfemoral procedures) using a petrous “locking in” technique, ³ whereby the system is tracked to the petrous ICA around a single horizontal 90° turn and stabilized in this position, maintaining position for subsequent intracranial interventions. This technique was recently shown to correlate with improved clot clearance when compared with more proximal guide placement. ⁴ Therefore, placement location of the access catheter was also an important procedural concern. We were able to navigate the NeuGlide to the distal cervical or petrous ICA in all cases where ICA navigation was required and the device was able to be navigated over the glidewire without having to advance the Simmons 2 or vertebral catheter.

However, current catheters still have limitations in compatibility with 7Fr short sheaths and 6Fr intermediate catheters. No previous study has reported the use of a 7Fr radial sheath and 6Fr intermediate catheter in a single transradial procedure. Thus, while a relatively small sample size, the cases reported here provide efficacy and safety data, as well as procedural feasibility data, with a system that allows operators to deliver 6Fr aspiration catheters (which are often used in thrombectomy procedures) and roadmap around 5Fr distal access catheters that are commonly used during intracranial embolizations.

The technical results reported in this series are similar or even favorable to those reported for smaller-ID catheters such as the RIST and BMX 81. In a multicenter series of 152 radial cases using the RIST, Abecassis et al. reported a 96% success rate and a 3% overall complication rate while we report a 97.5% success rate and 0% complication rate. In a series of 90 consecutive patients undergoing intervention with the BMX 81, Abdelsalam et al. reported that 51 patients underwent transradial intervention and 12% had to undergo conversion from radial to femoral and complications were similarly low. ⁵ In a series comparing RIST to Armadillo, El Naamani et al. reported failure to catheterize the target vessel of 1% in both Armadillo and RIST study arms and conversion-to-femoral rates of 2% in each arm with low rates of access site and neurological complications. ⁶ Compared to larger-bore radial-specific catheters such as the Zoom RDL, this study's procedural outcomes were similar, while also allowing for deliverability through a 7Fr sheath reducing risk of catheter entrapment. ⁷ In a series of 29 patients undergoing intervention with Zoom RDL, Morsi et al. reported a technical failure rate of 10% with low access complications. ⁷ In a series of 91 patients undergoing transradial interventions with the Ballast long sheath (which is not radial-specific), target vessel catheterization was achieved in 100% of procedures, with no complications, but transfemoral conversion was required in 3.3% of patients. ⁸

7Fr 87 NeuGlide catheter design implications

The 7Fr 87 NeuGlide catheter's design, as detailed above, reduces catheter wall thickness, enabling the first cases where guide catheter provides 7Fr short sheath compatibility and a full 0.087″ lumen, overcoming the previous limitation of using modern intermediate devices through radial guide catheters. Iterative in vitro feedback on catheter construction enabled smooth navigation from the radial artery to the ICA and stable support during introduction of treatment devices. Its 7Fr outer diameter provides the critical compatibility with 7Fr short sheaths that fit into the majority of radial arteries and ensure low rates of access-site complications in transradial procedures. ⁹ The ID of 0.087″ enables the successful roadmapping reported here as well as compatibility with modern 6Fr aspiration and intermediate catheters.

Limitations

Our study has several limitations. This was a retrospective study and is at risk of selection bias. No core lab was used for the assessment of angiographic, technical, and clinical outcomes. We report a relatively small sample size, and the results of a wide range of procedure types performed means it will be necessary to perform larger studies focused on specific disease states (such as aneurysm repair or stroke thrombectomy) to confirm the safety and effectiveness of transradial procedures using the 7Fr 87 NeuGlide catheter. Larger multicenter studies are needed to demonstrate generalizability and reproducibility of our findings.

Conclusions

We found that the FDA-cleared 7Fr 87 NeuGlide catheter from Piraeus Medical, Inc. is safe and effective for transradial neuroendovascular interventions. We report a high technical success rate of 97.5% and no complications. Successful roadmapping around a 5Fr distal access catheter and petrous “locking in” techniques were also both demonstrated in a wide range of transradial procedures.