The following video demonstrates the use of the right transradial approach for anterior circulation aneurysm coiling.

Micropuncture access of the right radial artery was obtained and a 6F introducer sheath is placed (GLIDESHEATH, Terumo, Somerset, NJ). The video begins with a radial artery angiogram to evaluate for loops or spasm. An 0.071'' ID guide catheter (Envoy DA, Codman, Raynham, MA) is guided over a 125cm 5F Simmons 2-shaped diagnostic catheter (Select, Penumbra, Alameda, CA) using a 180cm soft-tipped hydrophilic coated wire (GLIDEWIRE, Terumo, Somerset, NJ) through the radial and brachial arterty into right subclavian artery. The guide catheter remains in the subclavian artery while the diagnostic catheter shape is formed by advancing the catheter over the wire that has been reflected off of the aortic valve. Once the catheter shape has been formed, the wire is removed, and using a contrast 'puffing' technique, the left common carotid artery (CCA) is selected with the catheter.

The lateral plane collimator is unlinked from the AP, and advanced superiorly 8-12 cm to ensure the aortic arch and carotid bifurcation can be viewed simultaneously. A roadmap injection is then performed. Under roadmap guidance, the wire is advanced into the distal left internal carotid artery (ICA). Care must be taken to ensure that the proximal curve remains apposed to the junction of the innominate artery, aortic arch wall and left common carotid artery ostia. The guide catheter is then advanced to the tip of the diagnostic catheter. With the guide catheter now in the left CCA, the diagnostic catheter is advanced into the distal ICA over the wire. Then, the guide catheter is advanced over the diagnostic catheter into the distal ICA. The diagnostic catheter and wire are removed.