Distal Transradial Artery Access for Neuroangiography and Neurointerventions

Abstract

Introduction The distal transradial approach (dTRA) is progressively gaining more clinical use in the fields of cardiology and other vascular interventions, as it offers a number of advantages compared to conventional radial approach (TRA). These include lower rates of vascular occlusion which permits preservation of the proximal radial artery for future procedures in the event of a distal occlusion. Aim To share the experience in the use of dTRA for neurointerventions, showing its advantages, pitfalls as well as sharing our optimized puncture and hemostatic ultrarapid compression protocols to improve the use of this vascular access. Methods A retrospective analysis of our experience of diagnostic and interventional procedures performed via dTRA using an optimized protocol for puncture and postpuncture compression of the dTRA was performed. The rate of complications (hematoma and arterial dissection at puncture site) femoral crossover, and assessment of postprocedural stenosis/occlusion with the ultrarapid compression protocol were also assessed. Results From March 2019 to July 2020 a total of 100 distal radial procedures were carried out and 53 diagnostic angiograms (53%) and 47 interventional procedures (47%) were included in the analysis. We achieved a 96% technical success, with a femoral crossover requirement in 3 cases (3%), and one conventional TRA crossover due to puncture failure. Of the patients 3 presented puncture site hematomas (3%) with no intervention required, 61 patients (61%) underwent the ultrarapid hemostasis protocol in association with a hemostatic pad. Ultrasound follow-up was performed in 20 patients (20%) at 1-2 months with 1 case of occlusion (5%) and 2 of radial stenosis (10%). In all 3 cases proximal radial artery remained patent. Conclusion The dTRA is a safe and feasible access route for angiography and neurointerventions. Using vasodilators prepuncture, we attained a variable increase in the vascular diameter facilitating puncture and reducing the risk of occlusion and vascular spasm. A rapid deflation protocol for postpuncture hemostasis does not significantly increase the hematoma rate.

Distal transradial access for targeted spinal angiography and embolization

“…There is more recent published literature on the use of the distal radial artery for Neuroangiography and interventions for a wide variety of cases. [10][11][12] The use of radial access for spinal angiography has not been widely reported. There is possibly a significant advantage in spinal angiography patients where postprocedural lower extremity neurological evaluation is not limited by strict immobility protocols.…”

“…There is more recent published literature on the use of the distal radial artery for Neuroangiography and interventions for a wide variety of cases. 10 – 12 …”

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

“…Several studies have reported the use of the DRA in neuroendovascular treatment, as shown in Table 3. [17][18][19][20][21][22][23][24][25] The DRA has been used to treat various diseases, including aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistulas, carotid artery stenosis, and acute cerebral infarction. The guiding sheath is selected from amongst 4-to 6-Fr systems, except for one case where a 7-Fr system was used.…”

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

“…Distal TRA (dTRA) has recently received more attention in an attempt to overcome some of the limitations of conventional radial access [44], with successful results using dTRA for diagnostic angiographies and neurointerventions [7,45]. In patients with posterior circulation stroke, left dTRA is particularly useful to perform left vertebral artery access via the left forearm.…”