Distal Transradial Access for Diagnostic Cerebral Angiography and Neurointervention: Systematic Review and Meta-analysis

Hoffman, Haydn; Jalal, Muhammad S.; Masoud, Hesham; Pons, R; Caamaño, Isabel Rodríguez; Khandelwal, Priyank; Prakash, Tannavi; Gould, Grahame

doi:10.3174/ajnr.a7074

Cited by 20 publications

(16 citation statements)

References 31 publications

(55 reference statements)

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“…Nevertheless, guidelines across the nation are in the favor of the traditional access via the proximal forearm and the groin due to the relatively lesser data on the use of dTRA. [ 2 , 5 , 12 ] One factor that may serve to limit the use of the approach by hospitals across the nation may include the steeper learning curve associated with the approach due to the smaller diameter of the distal branch, a more angular route of the artery as compared to the relatively straight path in the forearm, and the design of catheters specific to the traditional approaches rather than the “novel” relatively longer path through the distal branch.…”

Section: Discussionmentioning

confidence: 99%

Initial experience of subcutaneous nitroglycerin for distal transradial access in neurointerventions

Ahmed

Zyck

Gould

2021

Surgical Neurology International

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Background: Transradial access (TRA) for diagnostic and interventional neuroendovascular procedures has gained significant popularity in recent years due to its improved safety profile and appeal to patients compared with transfemoral access. However, risks of TRA include hand ischemia in cases of poor ulnar collateral circulation and inability to cannulate the radial artery due to its relatively small diameter. By accessing the radial artery distal to the superficial palmar arch where ulnar collateral blood flow arises, in the anatomic snuffbox, the risk of hand ischemia is theoretically eliminated. The use of subcutaneous nitroglycerin and lidocaine to improve rates of success in radial artery access has been reported in the cardiac literature, however, has yet to be described for neurointerventional procedures. We discuss our technique and report our initial experience using subcutaneous nitroglycerin and lidocaine cocktail for access to the distal transradial artery in a variety of neuroendovascular procedures. Methods: A retrospective review of our institution’s database of neurointerventional and diagnostic procedures performed using dTRA was conducted, and 64 patients were identified between February and December 2020. Patient demographics, clinical data, procedural details, and radiographic information were collected and analyzed. Results: A total of 64 patients underwent neurointerventional procedures using the subcutaneous injection for dTRA access. The procedures performed included diagnostic cerebral angiograms (n = 47), stent and balloon assisted aneurysm coiling (n = 5), flow diversion (n = 2), intra-saccular device placement (n = 1), mechanical thrombectomy (n = 1), tumor embolization (n = 1), middle meningeal artery embolization (n = 2), extracranial carotid stent placement (n = 2), and arteriovenous malformation embolization (n = 3). While no complications of hand ischemia were appreciated, the access site conversion rate was 3.1%; 2 cases required a switch to femoral artery access due to proximal vessel tortuosity and aortic anatomical variations, and not due to access site complication. Furthermore, on repeat angiograms by the same proceduralist, distal TRA (dTRA) was successful in 100% of the cases. Conclusion: dTRA using subcutaneous nitroglycerin and lidocaine is a safe and effective method for neurointerventional and diagnostic procedures.

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Section: Discussionmentioning

confidence: 99%

Initial experience of subcutaneous nitroglycerin for distal transradial access in neurointerventions

Ahmed

Zyck

Gould

2021

Surgical Neurology International

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“…This technique was introduced as a method to facilitate retrograde radial artery recanalization and has been increasingly adopted by interventional cardiology and radiology in recent years, [3][4][5][6] with neurointerventional procedures now starting to show similar promise. [7][8][9][10][11][12] Because distal TRA (dTRA) involves puncture within the anatomic snuffbox distal to the origin of the superficial palmar arch branch, the risk of hand ischemia resulting from radial artery occlusion is substantially reduced. If the radial artery occludes at the dTRA puncture site, the superficial palmar branch, arising proximally, continues to provide blood supply to the hand.…”

Section: Distal Transradial Accessmentioning

confidence: 99%

Radial artery access anatomy: considerations for neuroendovascular procedures

Narsinh

Mirza

Duvvuri

et al. 2021

J NeuroIntervent Surg

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Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we will review important anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. These include normal and variant radial artery anatomy, the anatomic snuffbox, as well as axillary, brachial, and great vessel arterial anatomy that is imperative for the neuroendovascular surgeon to be intimately familiar prior to pursuing transradial access procedures. In the next part of the review series, we will focus on safety and complications specific to a transradial approach.

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“…The preferred access was on the right arm, except for catheterization of the left vertebral artery where left distal TRA is more convenient and allows having the hand of the patient in a prone position [19]. We used a Hockey stick 18 MHz ultrasound both for puncture and to measure the diameter of the artery (radial or ulnar) to select patients properly.…”

Section: Access and Proceduresmentioning

confidence: 99%

Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center

et al. 2021

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Purpose To compare clinical outcomes and safety of transradial (TRA) versus transfemoral access (TFA) for endovascular mechanical thrombectomy in acute stroke patients. Methods Retrospective analysis of 832 consecutive patients with acute stroke undergoing interventional thrombectomy using TRA (n = 64) or TFA (n = 768). Results Direct TFA failures occurred in 36 patients, 18 of which underwent crossover TFA to TRA, while direct TRA failures occurred in 2 patients having both crossovers to TFA. Successful catheterization was achieved in 96.8% (62/64) and 95.3% (732/768) of patients undergoing direct TRA and direct TFA, respectively, without significant differences. The median (IQR) catheterization time was 10 (8-16) min in the direct TRA group and 15 (10-20) in the direct TFA group (P < 0.001). This difference was also significant in the subgroup of anterior circulation strokes and in patients younger and older than 80 years of age. The majority of procedures yielded thrombolysis in cerebral infarction grade 2b/2c/3 revascularization in patients undergoing direct TRA (88.5%) and direct TFA (90.8%), without statistically significant differences. The median (IQR) puncture to recanalization time was 37 (24-58) min for the direct TRA group and 42 (28-70) min for the direct TFA group. Significant differences in access site complications, symptomatic ICH, and mRS score 0-2 at 90 days between both TRA and TFA accesses were not found. Conclusions TRA is not inferior to TFA in the probability of catheterization, times of catheterization and revascularization, and other clinical outcomes for mechanical thrombectomy in acute stroke.

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Distal Transradial Access for Diagnostic Cerebral Angiography and Neurointervention: Systematic Review and Meta-analysis

Cited by 20 publications

References 31 publications

Initial experience of subcutaneous nitroglycerin for distal transradial access in neurointerventions

Initial experience of subcutaneous nitroglycerin for distal transradial access in neurointerventions

Radial artery access anatomy: considerations for neuroendovascular procedures

Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center

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