Radial artery access anatomy: considerations for neuroendovascular procedures

Abstract

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.

Transradial Approach for Thoracolumbar Spinal Angiography and Tumor Embolization: Feasibility and Technical Considerations

“…In our practice, this initial navigation is performed using angiographic roadmapping to identify variant anatomy (e.g., high brachial bifurcation, tortuous loop). 6 Navigating the transition from innominate artery to aortic arch presents a variable challenge, but it was not difficult in this case. Theoretically, excess aortic stiffness and angulation can substantially increase torque on the catheter, rendering even to-and-fro movements cumbersome and resulting in longer procedure times.…”

“…In most patients, the course from radial artery to descending aorta is relatively conventional in which a diagnostic catheter is advanced over a hydrophilic guidewire without significant technical difficulty. In our practice, this initial navigation is performed using angiographic roadmapping to identify variant anatomy (e.g., high brachial bifurcation, tortuous loop) [ 6 ]. Navigating the transition from innominate artery to aortic arch presents a variable challenge, but it was not difficult in this case.…”

“…Comprehensive spinal angiography with the TRA must enable catheterization of the cervical, thoracic, and lumbar spine as well as pelvic vasculature [ 5 ]. Medullary arteries of the cervical spinal cord arise from the vertebral arteries, which are routinely catheterized in transradial cerebral angiography [ 6 ]. While the right vertebral artery is easier to catheterize from the right radial artery, the left vertebral artery may be catheterized most successfully with a Simmons II or Simmons III diagnostic catheter [ 12 ].…”

“…Recently, the transradial approach (TRA) for arterial access has emerged as a versatile approach for neuroendovascular surgery [ 6 ]. This approach has proved safe when appropriate techniques and precautions are employed [ 7 ].…”

“…5 Recently, the transradial approach (TRA) for arterial access has emerged as a versatile approach for neuroendovascular surgery. 6 This approach has proved safe when appropriate techniques and precautions are employed. 7 Although the rapidly growing literature asserts non-inferiority benefits of the TRA, these reports are largely limited to cervical and intracranial interventions.…”