Adoption of the Transradial Approach for Neurointerventions: A National Survey of Current Practitioners

Das, Somnath; Ramesh, Sunidhi; Velagapudi, Lohit; Sweid, Ahmad; Gooch, Reid; Tjoumakaris, Stavropoula; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1016/j.jstrokecerebrovasdis.2020.105589

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…We chose to use the 10-item Patient-Reported Outcomes measurement Information System GHS because it is a well-known valid and reliable scale used in assessing and tracking the impact of healthcare interventions in health and functional disability over time. This novel finding from our 30-day postprocedural PRO adds to previous literature [1][2][3][4][5] that only reported immediate QOL outcome with the TRA approach during the postoperative phase. These studies demonstrated a higher satisfaction rate with the radial approach mainly because of a shorter recovery time likely related to postprocedural comfort and reduced hospital stay.…”

Section: Discussionsupporting

confidence: 66%

“…Cerebral angiography remains the gold standard fluoroscopic imaging procedure for diagnosing cerebrovascular diseases, and the transfemoral arterial access (TFA) has been the conventional approach. There is a growing trend to perform Diagnostic Cerebral angiogram (DCA) using the transradial arterial access (TRA) due to recent data demonstrating improved outcomes with decreased complications,1–5 6 7 8 hence a safer and more feasible alternate technique.…”

Section: Introductionmentioning

confidence: 99%

“…However, the studies comparing TRA versus TFA approaches have not been comprehensive and have mostly only evaluated the absorbed radiation dose as a secondary outcome variable. Also, data on quality of life (QOL)/patient satisfaction in previous studies2 5 14 has been limited to postprocedure complication rate and recovery time. In our study, we chose a globally accepted patient reported QOL outcomes scale and to our knowledge, no prior study has also analysed and compared patient-reported QOL outcomes between these two approaches at 30 days postprocedure.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of radiation exposure and clinical outcomes between transradial and transfemoral diagnostic cerebral approaches: a retrospective study

Amankwah

Lombardo

Rutledge

et al. 2022

BMJ Surg Interv Health Technologies

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ObjectiveTo identify and compare patient and procedural variables that are associated with a high radiation dose exposure and worse clinical outcomes between transradial arterial (TRA) and transfemoral arterial (TFA) approaches.DesignThis was a retrospective analysis.SettingA community hospital during the initial phase of adopting a TRA-first approach.ParticipantsA resultant 215 subjects who only underwent diagnostic cerebral angiograms (DCA) after excluding all therapeutic procedures and patients under 18 years.InterventionsOnly DCA from 1 May 2018 to 31 January 2021.Main outcome measuresWe compared radiation exposure parameters (total fluoroscopy time (FT), total radiation dose (TD) and dose area product (DAP), number of vessels injected and Patient-Reported Global Health Physical and Mental Outcome Scores (PROGHS) at 30 days postprocedure between groups.ResultsFT was significantly greater in TRA compared with TFA (p<0.001). In addition, TRA had a significantly higher TD (p=0.002) and DAP (p=0.005) when compared with TFA. Analysis of only 6-vessel DCAs also showed that TRA had a significantly higher FT, DAP and TD in comparison to TFA. Despite observing a longer FT in TRA, results showed fewer vessels injected and a notably lower success rate in acquiring a 6-vessel DCA using the TRA. Further analysis of the effect of vessel number on FT using general linear models showed that with every increase of one vessel, the FT increases by 2.2 min for TRA (p<0.001; 95% CI 1.03 to 3.36) and by 1.3 min for TFA (p<0.001; 95% CI 0.72 to 1.83). There was no significant difference between groups in PROGHS mental and physical t-scores at 30 days postprocedure, even though our cohort showed a significantly greater percentage of TRA procedures done in the outpatient setting.ConclusionsAdopting a TRA first approach for DCAs may be initially associated with a higher radiation dose for the patient. Better strategies and devices are needed to mitigate this effect.

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Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of radiation exposure and clinical outcomes between transradial and transfemoral diagnostic cerebral approaches: a retrospective study

Amankwah

Lombardo

Rutledge

et al. 2022

BMJ Surg Interv Health Technologies

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“…[29][30][31] Transradial access is gaining popularity in the neuroendovascular setting as well 6,7 and its adoption appears to be motivated by apprehension surrounding access-site complications. 32 Underscoring this, a recent study by Munich and colleagues reported a complication rate of 5.4% (7/129) with transfemoral access, compared with 0% (0/44) with transradial access, for EVT. 8 However, the unique challenges presented by transradial access included increased time for vascular access, prevalent radial artery tortuosity, and arterial spasm.…”

Section: Discussionmentioning

confidence: 98%

“…8 However, the unique challenges presented by transradial access included increased time for vascular access, prevalent radial artery tortuosity, and arterial spasm. 32 Transfemoral access for EVT therefore continues to play an important role in ischemic stroke management, sustaining the value of US in potentially improving the safety profile of this method.…”

Section: Discussionmentioning

confidence: 99%

Access-site complications in ultrasound-guided endovascular thrombectomy: a single-institution retrospective cohort study

Brenna¹,

Pasarikovski

et al. 2021

Neurosurgical Focus

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OBJECTIVE Mechanical endovascular thrombectomy (EVT) is an increasingly relied-on treatment for clot retrieval in the context of ischemic strokes, which otherwise are associated with significant morbidity and mortality. Despite several known risks associated with this procedure, there is a high degree of technical heterogeneity across both centers and operators. The most common procedural complications occur at the point of transfemoral access (the common femoral artery), and include access-site hematomas, dissections, and pseudoaneurysms. Other interventional fields have previously popularized the use of ultrasound to enhance the anatomical localization of structures relevant to vascular access and thereby reducing access-site complications. In this study, the authors aimed to describe the ultrasound-guided EVT technique performed at a large, quaternary neurovascular referral center, and to characterize the effects of ultrasound guidance on access-site complications. METHODS A retrospective chart review of all patients treated with EVT at a single center between January 2013 and August 2020 was performed. Patients in this cohort were treated using a universal, unique, ultrasound-guided, single-wall puncture technique, which bears several theoretical advantages over the standard technique of arterial puncture via palpation. RESULTS There were 479 patients treated with EVT within the study period. Twenty patients in the cohort were identified as having experienced some form of access-site complication. Eight (1.67%) of these patients experienced minor access-site complications, all of which were groin hematomas and none of which were clinically significant, as defined by requiring surgical or interventional management or transfusion. The remaining 12 patients experienced arterial dissection (n = 5), arterial pseudoaneurysm (n = 4), retroperitoneal hematoma (n = 2), or arterial occlusion (n = 1), with only 1.04% (5/479) requiring surgical or interventional management or transfusion. CONCLUSIONS The authors found an overall reduction in total access-site complications as well as minor access-site complications in the study cohort compared with previously published randomized controlled trials and observational studies in the recent literature. The findings suggested that there may be a role for routine use of ultrasound-guided puncture techniques in EVT to decrease rates of complications.

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Trans-radial cerebral angiography for stereotactic radiosurgery treatment of arteriovenous malformations

Kular,

Maiter,

Martin

et al. 2024

Clinical Radiology

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Adoption of the Transradial Approach for Neurointerventions: A National Survey of Current Practitioners

Cited by 9 publications

References 27 publications

Comparison of radiation exposure and clinical outcomes between transradial and transfemoral diagnostic cerebral approaches: a retrospective study

Comparison of radiation exposure and clinical outcomes between transradial and transfemoral diagnostic cerebral approaches: a retrospective study

Access-site complications in ultrasound-guided endovascular thrombectomy: a single-institution retrospective cohort study

Trans-radial cerebral angiography for stereotactic radiosurgery treatment of arteriovenous malformations

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