Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study

Abstract

PurposeTo report the first use of distal radial artery (dRA) access for a variety of neurointerventions and to demonstrate the safety and feasibility of this approach.MethodsA retrospective review of our prospective neurointerventional database of endovascular interventions was conducted and, between May and October 2019, all patients in whom the intervention was performed via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data were collected.Results48 patients with a mean age of 64.4 years (range 35–84 years) were included. 27 patients were female. dRA access was achieved in all cases. Conversion to femoral access was required in five cases (10.4%) due to tortuous vessel anatomy and limited support of the catheters in the aortic arch. Interventions performed included aneurysm treatment (with flow diverters, Woven EndoBridge device placement, coiling or stent-assisted coiling), arteriovenous malformation and dural arteriovenous fistula embolization, carotid artery stentings, stroke thrombectomy, thrombolysis for central retinal artery occlusion, intracranial stenting, middle meningeal artery embolization, vasospasm treatment, and spinal angiography with embolization. Radial artery vasospasm was seen in two cases and successfully treated with antispasmolytic medication. No symptomatic radial artery occlusion or ischemic event was observed.ConclusiondRA access is safe and effective for a variety of neurointerventions. Our preliminary experience with this approach is very promising and shows high patient satisfaction.

Improved Fluoroscopy and Time Efficiency with Radial Access for Diagnostic Cerebral Angiography

“…This cardiology study and others proved the efficacy and patient preference for undergoing operations through the radial artery as opposed to the femoral artery 3,10–12 . Other retrospective analyses of the radial and femoral artery approach confirmed the safety of this approach for cerebral angiograms; 2,8,13,14 additionally, a study published in the Journal of Vascular and Interventional Neurology explained that many institutions are reluctant to switch from the femoral access point and that more studies are needed to establish the radial artery as a standard of care for patients requiring cerebral angiograms 7…”

“…Based on this study, it is imperative to recognize the necessary shift in medical practice for patients undergoing cerebral angiograms. Patient recovery time is decreased and patients report less pain postoperatively considering the location of the radial artery 2,7,8,13,14 . Most patients prefer a puncture in the wrist as opposed to a groin puncture, which shortens recovery time.…”

Safety and feasibility of the distal transradial approach: A novel technique for diagnostic cerebral angiography

“…[2][3][4]9 In previous four reports of neurointervention, 5-6 Fr introducer sheaths were used. [12][13][14][15] A prospective study showed an association between the size mismatch of the radial artery and introducer sheath for radial artery occlusion after TRA. When the ratio of the inner diameter of the radial artery and the outer diameter of the introducer sheath is less than one, the risk of radial artery occlusion is much higher (48.7%).…”

Transradial Carotid Artery Stenting in a Patient with Leriche Syndrome

“…Therefore, transradial access can be considered to be the ideal alternative to the traditional transfemoral approach when there are limitations for transfemoral access. The transradial approach was first introduced in 1989 in cardiology and several large interventional cardiology studies have shown the benefit of the transradial approach over the transfemoral approach and now it has been a standard access site in the cardiology field [4]. There are several A meta-analysis of seven eligible studies of the radial approach for CAS reported a procedural success rate of 90.8% [4].…”

“…Allen's test is crucial before transradial approach to prevent major complications of symptomatic RAO. Kuhn et al [4] reported a distal radial artery access which is a radial approach done distally in the anatomical snuffbox to lower risk of symptomatic RAO. The site of the arteriotomy is distal to the origin of the superficial palmar arch, so even if the access site occludes, the risk of ischemic symptoms will below.…”