Overtake Technique for Navigating 8Fr Emboguard Balloon Guide Catheter for Anterior Circulation Neurointervention - Clinical Research

Sep 30, 2026

Uploaded by hdkawk

Transradial approach (TRA) using balloon guide catheters (BGCs) has expanded as a neurointerventional option, but large-bore 8Fr systems may be constrained by radial artery size and technical difficulty when shifting from the right radial artery to the left anterior circulation. This study evaluated feasibility and safety of an overtake navigation technique for 8Fr EmboGuard BGCs under TRA, with radial arteries sized ≥2.8 mm, and assessed procedural success and clinical outcomes at 90 days or later.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Background and Objectives

Methods

Patients’ Population and Outcomes

Results

Conclusion

Key Words

Abbreviations

TRA EmboGuard BGC Technique

CLINICAL RESEARCH Overtake Technique for Navigating 8Fr Emboguard Balloon Guide Catheter for Anterior Circulation Neurointervention Kenya Miyoshi, MD, PhD1, Daigo Kojima, MD, PhD2, Kohei Chida, MD, PhD1, Wataru Yanagihara, MD, PhD1, Koji Yoshida, MD, PhD3, Toshinari Misaki, MD, PhD3, Hiroshi Kashimura, MD, PhD2, Yosuke Akamatsu, MD, PhD 1 1Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan; 2Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; 3Department of Neurosurgery, Hachinohe Red Cross Hospital, Hachinohe, Aomori, Japan Correspondence: Yosuke Akamatsu, MD, PhD, Department of Neurosurgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Iwate 028-3694, Japan. Email: [akamatsu@iwate-med.ac.jp](akamatsu@iwate-med.ac.jp) Received, August 12, 2025; Accepted, October 30, 2025; Published Online, January 8, 2026. Neurosurgery Practice 2026;7(1):e000196. [https://doi.org/10.1227/neuprac.0000000000000196](https://doi.org/10.1227/neuprac.0000000000000196) © The Author(s) 2026. Published by Wolters Kluwer Health, Inc. on behalf of Congress of Neurological Surgeons. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. BACKGROUND AND OBJECTIVES: The transradial approach (TRA) using balloon guide catheters (BGCs) has emerged asa neurointerventional option. However, the use of large-bore BGCs may be limited because of the small size of the radial arteries (RAs) and difﬁculty in navigating BGCs from the right RA to the left anterior circulation. To determine the feasibility and safety of the overtake technique for navigating 8Fr EmboGuard BGCs using the TRA. METHODS: We retrospectively reviewed consecutive patients primarily undergoing TRA using EmboGuard BGCs. The BGCs were placed using sheathless or sheath-based methods and navigated by overtaking long Simmons arm inner catheters hooked in the common carotid arteries under the guidance of a half-stiff wire. The minimum diameter of RAs was ≥2.8 mm in all patients. Patient demographics and procedural and clinical outcomes were evaluated at 90 d or later. RESULTS: Overall, 28 procedures were performed in 26 patients out of 364 procedures in 358 patients. Treatments were successfully completed with the 8Fr EmboGuard TRA in 27 procedures (96.4%) without conversion to the transfemoral approach. In one patient, exchanging the EmboGuard with another BGC was necessary due to herniation of the BGC into the aortic arch during navigation of the carotid stent system. RA occlusion occurred in 1 of 22 patients (3.8%) without ischemic complications. CONCLUSION: The overtake technique for navigating the 8Fr EmboGuard BGCs in patients having RAs ≥2.8 mm was feasible and safely performed regardless of the insertion methods. KEY WORDS: Neurointervention, Transradial approach, Balloon guide catheter, Safety The neurointervention through transradial approach (TRA) has emerged as an alternative to transfemoral approach (TFA) after the publication of level 1 evidences showing the beneﬁt of TRA over TFA in interventional cardiology.1,2 However, the use of large bore balloon guide catheter (BGC) may be limited due to the small size of the radial arteries (RAs) and the difﬁculty in navigating the BGCs from the right RA to the left anterior circulation.3-6 In this article, we demonstrate the feasibility and safety of a simple technique for navigating 8Fr EmboGuard BGCs by overtaking the inner catheters for anterior circulation neurointervention. METHODS Patients’ Population and Outcomes We performed a retrospective review of databases from 2 institutions in Japan, where neurointervention using both TR

FAQs

What problem does the study address regarding the transradial approach and 8Fr balloon guide catheters?

Large-bore balloon guide catheters can be limited by the small size of radial arteries and by difficulty navigating from the right radial artery to the left anterior circulation. The study targets these feasibility and safety constraints using an overtake technique.

How was the overtake technique performed for 8Fr EmboGuard balloon guide catheters?

The BGC navigation used overtaking of long Simmons arm inner catheters hooked in the common carotid arteries under guidance of a half-stiff wire. The technique was carried out using TRA with either sheathless or sheath-based placement methods.

What were the main feasibility and safety outcomes?

Treatment was successfully completed in 27 of 28 procedures (96.4%) without conversion to transfemoral access. Radial artery occlusion occurred in 1 of 22 patients (3.8%) without ischemic complications.

Sep 30, 2026

Uploaded by hdkawk