Access Site Complications and Management of the Transradial Approach for Neurointerventions

Abstract

BACKGROUND:The transradial approach has increasingly been used for neurointerventions because of the improved safety profile compared with transfemoral. However, it is important to be aware of potential complications such as radial artery (RA) spasm, RA occlusion, pseudoaneurysm, extravasation, arteriovenous fistula, and wrist hematoma as well as their management. OBJECTIVE: To present our institution's experience with the prevention and management of local access site complications associated with the transradial approach for neuroendovascular interventions. METHODS: We conducted a retrospective analysis of a prospectively maintained database and identified 1524 consecutive neuroendovascular procedures performed using transradial access from April 2018 to February 2021. RESULTS: Among 1524 procedures, local transradial complications occurred in 1.7%. Major complications occurred at a rate of 1.2% including RA extravasation (0.3%), delayed RA occlusion (0.6%), pseudoaneurysm (0.1%), compartment syndrome (0.1%), infection (0.1%), and avulsion of the RA in 0.1% (1 of 1524) with no serious clinical consequence. Although RA occlusion is included in major complications, all cases were asymptomatic and did not require any intervention. Minor complications occurred at a rate of 0.5% including severe RA spasm (0.3%) and hematoma (0.3%). No patient in the cohort died or suffered from permanent disability from a complication related to the transradial approach. CONCLUSION: Transradial access for neurointervention has a low rate of local complications, particularly when taking appropriate prevention measures. Appropriate management of complications can prevent procedural failure and has low morbidity rates demonstrating the overall safety profile of transradial access even when complications occur.

Compartment syndrome associated with vascular avulsion caused by transradial access in neurointervention for unruptured intracranial aneurysm: illustrative case

“… 4 In the neurointerventional field, among 1524 TRA procedures, ACS occurred in only 1 case (0.1%). 2 Regardless of the low incidence, the possibility of postoperative ACS should be taken seriously because delayed diagnosis could result in permanent sequelae, including irreversible necrosis and nerve damage in addition to tissue damage. 3 …”

“… 1 However, TRA, similar to TFA, might also cause major puncture-site complications, including radial artery (RA) extravasation, delayed RA occlusion, pseudoaneurysm, infection, acute compartment syndrome (ACS), and avulsion of the RA. 2 Among these, early diagnosis and treatment of ACS are particularly imperative, since delays in appropriate management can lead to permanent sequelae, such as irreversible necrosis, nerve injury, and tissue damage. 3 In the field of neurointervention, although several reports have documented the frequency of postoperative ACS, few have described the clinical course and how to rescue this critical situation.…”

Distal radial artery approach is safe and effective for cerebral angiography and neuroendovascular treatment: A single-center experience with ultrasonographic measurement

“…1,2 Reportedly, in the cerebrovascular field, the TRA is sufficient for completing examinations and neuroendovascular treatment, except in cases where definitive selection of the branches of the external carotid artery or left vertebral artery is necessary. [3][4][5] Recently, the distal radial artery approach (DRA), which involves puncturing the radial artery (RA) running through the anatomical snuffbox, has garnered attention as a less invasive approach. [6][7][8] An additional advantage is that there is minimal restriction of patient movement after the test.…”

“…1,2 Reportedly, in the cerebrovascular field, the TRA is sufficient for completing examinations and neuroendovascular treatment, except in cases where definitive selection of the branches of the external carotid artery or left vertebral artery is necessary. 3–5…”

Letter: Transradial Carotid Artery Stenting Using Walrus Balloon Guide Catheter: Technical Aspects and Clinical Outcome

“…10 Furthermore, RAS can cause rare but serious access site complications, such as perforation, dissection, eversion or avulsion of the radial artery, catheter/sheath entrapment, and forearm hematoma leading to compartment syndrome. 8,[11][12][13][14][15] Maintaining the radial artery patency is important because radial artery occlusion prevents future use of the radial artery for vascular access in interventional procedures, as a donor vessel in bypass surgery, or for the construction of an arteriovenous fistulae in patients with end-stage renal disease. 16,17 Rathore et al 5 showed that RAS and discomfort were significantly reduced in patients with hydrophilic-coated sheaths, with no difference between long or short sheaths.…”