Transradial access for neurointerventions: management of access challenges and complications

Brunet, Marie-Christine; Chen, Stephanie H.; Peterson, Eric C.

doi:10.1136/neurintsurg-2019-015145

Cited by 84 publications

(74 citation statements)

References 43 publications

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“…The radial artery approach has become an increasingly popular alternative for arterial access in endovascular interventions 1. First described by Campeau2 nearly three decades ago, the use of a percutaneous radial artery approach for angiography has seen a significant increase in the field of interventional cardiology owing to comparative data demonstrating superiority in clinical outcome, patient satisfaction, and cost reduction compared with the standard femoral artery access 2–11.…”

Section: Introductionmentioning

confidence: 99%

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

Catapano

Fredrickson

Fujii

et al. 2019

J NeuroIntervent Surg

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BackgroundThe transradial artery (TRA) approach for neuroendovascular procedures continues to gain popularity, but neurointerventionalists still lag behind interventional cardiologists in the adoption of a TRA-first approach. This study compares the complications and efficiency of the TRA approach to the standard transfemoral artery (TFA) approach at our institution during our initial phase of adopting a TRA-first approach.MethodsA retrospective analysis was performed on all consecutive neuroangiographic procedures performed at a large cerebrovascular center from October 1, 2018 to June 30, 2019. The standard TFA approach was compared with TRA access, with the primary outcome of complications analyzed via a propensity-adjusted analysis.ResultsA total of 1050 consecutive procedures were performed on 877 patients during this 9-month period; 206 (20%) procedures were performed via TRA and 844 (80%) via TFA. The overall complication rate was significantly higher with the TFA procedures than with the TRA procedures (7% (60/844) vs 2% (4/206), respectively; p=0.003). A propensity-adjusted analysis showed that the TFA approach was a significant risk factor for a complication (OR 3.6, 95% CI 1.3 to 10.2, p=0.01). However, the propensity analysis showed that fluoroscopy times were on average 4 min less for TFA procedures than for TRA procedures (p=0.003).ConclusionThe TRA approach for neuroendovascular procedures appears to be safer than the TFA approach. Although a steep learning curve is initially encountered when adopting the TRA approach, the transition to a TRA-first practice can be performed safely for neurointerventional procedures and may reduce complications.

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Section: Introductionmentioning

confidence: 99%

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

Catapano

Fredrickson

Fujii

et al. 2019

J NeuroIntervent Surg

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“…Two cases of asymptomatic radial occlusion were recorded at the beginning of our training experience, maybe due to bend error in decompression timing. In previous studies, compression time and pressure have been shown to contribute to radial artery occlusion (Cubero et al 2009 ); moreover, radial complication events (puncture failure, artery spasm and occlusion) would be less frequent as the interventionist gains experience (Liu et al 2019 ; Brunet et al 2020 ). In fact, Snelling et al ( Snelling et al 2018b ) demonstrated that the learning curve of the radial access rapidly improve between case 5 and case 15 in a neurointerventional scenario.…”

Section: Discussionmentioning

confidence: 99%

Trans-Radial Approach: technical and clinical outcomes in neurovascular procedures

et al. 2020

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Background To evaluate efficacy and safety of Trans-Radial Approach (TRA) in cerebral angiography for diagnostic and therapeutic purpose. Methods We retrospectively included consecutive patients eligible for TRA cerebral angiography at our Institution between September 2019 and January 2020. Cerebral DSA was classified in diagnostic (one-vessel imaging) or therapeutic (emergency/elective). Technical and clinical outcome were recorded for each group. Results A total of 61 TRA angiographies were evaluated. Right-sided TRA was obtained in 85,2% of all cases. Interventional procedures included 11 strokes, 2 ruptured aneurysms, 2 unrupted aneurysms, 1 DAVF and 3 symptomatic atheromatous intracranial stenosis. Successful TRA angiographies were obtained in 97,6% and 94,7% for diagnostic and therapeutic group, respectively. No major radial artery complications were recorded. Mean puncture-to-final angiogram was 11 and 62 min for diagnostic and therapeutic groups, respectively. Mean radial compression maintenance was 4 h, allowing patients discharge within 6 h in all cases undergone diagnostic angiography. Conclusions TRA could be a valid technique in terms of efficacy and safety both for diagnostic and therapeutic cerebral angiographies, with low complication rate.

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“…Thus, while neurointerventional procedures can be safely and successfully performed via 6 French and 7 French systems, their size may also increase the risk of RAO, precluding future TRA access. Accordingly, it is imperative to employ strategies to minimize the risk of RAO such as using the minimal size sheath or catheter that is necessary to accomplish the procedure, administering heparin and antispasmodics, and careful use of compression devices to close the arteriotomy with patent hemostasis 12 13 29…”

Section: Discussionmentioning

confidence: 99%

“…During the study period, operators included three neurointerventionalists (DRY, RMS, ECP) and six neurointerventional fellows (BS, SS, JC, PK, MCB, SC). We have previously described the set-up and technical details of our transradial procedures 4 12 15–19. Diagnostic cerebral angiography was performed with a 100 cm hydrophilic coated 5 French Simmons 1, Simmons 2, or Simmons 3 catheter through a 5 French radial sheath.…”

Section: Methodsmentioning

confidence: 99%

“…Led by the interventional cardiology community, multiple large randomized multicenter trials as well as meta-analyses have reported a greater than 60% reduction in vascular complications as well as significant decreases in all-cause mortality and net adverse clinical events with TRA 3 5–11. Despite the many advantages of TRA, there are also limitations including radial artery occlusion (RAO) and radial artery spasm 12. RAO is the most frequent complication of radial procedures with a reported incidence of 1–6% 13 14.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of repeat transradial access for neuroendovascular procedures

Chen

Brunet

Sur

et al. 2019

J NeuroIntervent Surg

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IntroductionTransradial artery access (TRA) for cerebrovascular angiography is increasing due to decreased access site complications and overwhelming patient preference. While interventional cardiologists have reported up to 10 successive TRA procedures via the same radial access site, this is the first study examining successive use of the same artery for repeat procedures in neurointerventional procedures.1 MethodsWe reviewed our prospective institutional database for all patients who underwent a transradial neurointerventional procedure between 2015 and 2019. Index procedures were defined as procedures performed via TRA after which there was a second TRA procedure attempted. Reasons for conversion to a transfemoral approach (TFA) for subsequent procedures were identified.Results104 patients underwent 237 procedures (230 TRA, 7 TFA). 97 patients underwent ≥2 TRA procedures, 20 patients >3, four patients >4, three patients >5, and two patients >6 TRA procedures. The success rate was 94.7% (126/133) with 52% (66/126) of successive procedures performed via the same radial access site (snuffbox vs antebrachial) while the alternate radial artery segment was used for access in 48% (60/126) of subsequent procedures. There were seven (5.3%) cases requiring crossover to TFA, six cases for radial artery occlusion (RAO) and one for radial artery narrowing.ConclusionSuccessive TRA is both technically feasible and safe for neuroendovascular procedures in up to six procedures. The low failure rate (5.3%) was primarily due to RAO. Thus, even without clinical consequences, strategies to minimize RAO should be optimized for patients to continue to benefit from TRA in future procedures.

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Transradial access for neurointerventions: management of access challenges and complications

Cited by 84 publications

References 43 publications

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

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

Trans-Radial Approach: technical and clinical outcomes in neurovascular procedures

Feasibility of repeat transradial access for neuroendovascular procedures

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