Radial Artery Catheterization for Neuroendovascular Procedures

Abstract

Background and Purpose— Radial artery catheterization is an alternate route of access that has started to gain more widespread use for neuroendovascular procedures, and there have been few studies that describe its safety and efficacy. We present our institution’s experience in performing neuroendovascular interventions via a transradial approach, with excellent clinical outcomes and patient satisfaction measures. Methods— We conducted a retrospective analysis and identified 223 patients who underwent 233 consecutive neuroendovascular interventions via radial artery access at our institution. The incidence of perioperative and postprocedural complications was investigated. We identified a subset of 98 patients who have undergone both transradial and transfemoral cerebral angiograms and compared clinical outcomes and patient satisfaction measures between the 2 groups. Results— The overall incidence of complications was low across all procedures performed via transradial access. Peri-procedurally, only 2 patients had symptomatic radial artery spasm, and there were no instances of iatrogenic complications (vessel dissection, stroke, and hemorrhage). In 10 cases (4.3%), the intended procedure could not be completed via a transradial approach, and, thus, femoral artery access had to be pursued instead. Ten patients complained of minor postprocedural complications, although none required therapeutic intervention. The mean procedure time was shorter for diagnostic angiograms performed via transradial versus transfemoral access (18.8±15.8 versus 39.5±31.1 minutes; P =0.025). Patients overall reported shorter recovery times with transradial access, and the majority of patients (94%) would elect to have subsequent procedures performed via this route. Conclusions— Radial artery catheterization is a safe and durable alternative to perform a wide range of neuroendovascular procedures, with a low rate of complications. On the whole, patients prefer transradial compared with transfemoral access.

Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment

“…In 2018, Snelling et al 22 found a similarly low rate of complications in 148 procedures using a TRA approach; no major complications but 10 (~6%) minor complications were noted. More recently, in 2019, Khanna et al 23 found 10 minor complications in 233 patients with a TRA neuroendovascular procedure. When complications were broken down by procedure type in our study, we found no significant difference in complication rates between TRA and TFA when performed for treatment; however, when analyzing diagnostic and vasospasm angiography procedures, the TFA approach had a 6% complication rate versus a 1% complication rate for the TRA approach (p=0.007).…”

“…The TRA approach for neuroendovascular procedures has continued to gain traction over the past several years with a wide array of benefits reported, including a reduced risk of severe complications 22 23. However, unlike in interventional cardiology, the use of TRA still remains secondary to a TFA approach for neurointerventional procedures, largely due to the general lack of large studies in this field 4 22.…”

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

“…However, given the indisputable advantages of wrist access, some neurovascular centers have recently accepted the challenge and switched their approach to a transradial access for diagnostic and interventional procedures with great success 1–6…”

“…The neurointerventional field has recently adopted the transradial approach for diagnostic angiographies and interventional procedures 1–6. Faster postprocedural recovery, higher patient satisfaction, and fewer access site complications are some of the major advantages of wrist access over the transfemoral approach.…”

Left transradial access for cerebral angiography

“…Cerebral angiography has seen a recent shift toward transradial access instead of traditional transfemoral access out of concerns for patient preference and safety 1–5. In neurovascular centers across the USA in 2016, up to 4.5% of mechanical thrombectomies for acute ischemic stroke were performed via transradial access 6.…”