Novel Distal Left Radial Artery Access in Anatomical Snuffbox for Recanalization of Proximal Radial Artery Total Occlusion and Percutaneous Coronary Intervention Through Left Internal Mammary Artery

Sheikh, A.; Abdelaal, Eltegani; Sastry, Sanjay; Karim, Shahid; Zeb, Mehmood

doi:10.1161/circinterventions.118.006579

Cited by 25 publications

(22 citation statements)

References 4 publications

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“…We encountered two patients with asymptomatic RAO, one after a diagnostic traditional transradial access procedure and the other at follow-up post dRA access intervention. In the case of radial artery thrombosis after traditional transradial access, we were able to recanalize the occluded radial artery in a retrograde fashion via the dRA approach—another advantage of dRA access previously described in the literature 26…”

Section: Discussionmentioning

confidence: 71%

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

Kühn

Rodrigues

Singh

et al. 2020

J NeuroIntervent Surg

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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.

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Section: Discussionmentioning

confidence: 71%

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

Kühn

Rodrigues

Singh

et al. 2020

J NeuroIntervent Surg

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“…Our search identified 162 unique citations, of which 20 articles describing 19 independent reports were eligible for inclusion ( Figure S1, supplementary appendix). 9,13,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] As two articles presented the results of the same study, 35,36 solely the publication with the complete dataset was included. 35 Reference searching of included studies identified one additional manuscript by Kaledin et al 27 hosted on a preprint server which was determined to be eligible.…”

Section: Resultsmentioning

confidence: 99%

“…Other infrequently reported procedural outcomes included a mean time to dTRA puncture of 1.19 min (n = 54, one study) 35 ; access success rate for left-sided access in 11/11 cases (100%) versus access success rate for right-sided access in 36/41 cases (87.8%) (n = 52, one study) 37 ; patient comfort during procedure in 22/22 cases (100%, one study) 20 ; successful angioplasty of radial artery occlusion via dTRA access in 9/9 cases (100%, two studies) 33,34 ; palpable dTRA pulse postprocedure in 76/76 cases (100%; two studies). 20,35 Of note, amongst patients with STEMI in Flores et al, 23 the average door-toballoon time was 46 min.…”

Section: Procedural Outcomesmentioning

confidence: 99%

Distal transradial access for cardiac catheterization: A systematic scoping review

Coomes

Haghbayan

Cheema

2019

Cathet Cardio Intervent

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Objective: Systematically review the literature for cardiac catheterization and coronary angiography via distal transradial access (dTRA) and its outcomes. Background: dTRA, via anatomical snuffbox, may have several advantages over conventional transradial access (cTRA) for percutaneous cardiac procedures, including easier left-sided access for aorto-coronary grafts, future proximal radial artery preservation, and patient and operator comfort. However, its procedural characteristics and safety profile remain unclear. Methods: Ovid MEDLINE and EMBASE were searched from inception to September 2018. Two authors independently performed two-stage selection and data extraction. Reports assessing the dTRA approach for cardiac intervention in adults reporting any outcomes were eligible. Descriptive summary statistics were calculated from pooled data. Results: A total of 19 publications comprising 4,212 participants undergoing dTRA were included. Mean age was 63.8 years, and 23.0% were female. dTRA was primarily undertaken for assessment of stable coronary artery disease (87.6%), with 41.7% for diagnostic procedures and 46.9% undergoing percutaneous coronary intervention. The overall success rate for undertaking the dTRA approach was 95.4% (69-100%). Complications occurred in 2.4% of cases, of which the leading complications were bleeding/hematoma (18.2%). Complication rates did not significantly differ between dTRA and cTRA. The occurrence of radial artery occlusion in patients undergoing dTRA was low (1.7%). Conclusions: Observational data demonstrate that dTRA is a safe and feasible method for percutaneous cardiac procedures, with high rates of procedural success and low rates of complication. As data comparing dTRA with cTRA remain limited, future high-quality randomized comparative studies are required.

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“…Recently, distal transradial access (dTRA) in the anatomical snuffbox has been introduced as a new technique for access [ 5 , 6 ]. Anatomically, the snuffbox is a triangular-shaped depression on the radial dorsal aspect of the hand, and the distal radial artery under the snuffbox, passing along the scaphoid and trapezium, is the deep palmar branch of the radial artery ( Fig 1 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study

et al. 2020

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Background Transradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the “snuffbox”, which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study. Material & methods Distal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period. Results The technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120–360 minutes). Conclusion Distal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.

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Novel Distal Left Radial Artery Access in Anatomical Snuffbox for Recanalization of Proximal Radial Artery Total Occlusion and Percutaneous Coronary Intervention Through Left Internal Mammary Artery

Cited by 25 publications

References 4 publications

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

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

Distal transradial access for cardiac catheterization: A systematic scoping review

Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study

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