Efficacy of Transradial Cerebral Angiography in the Elderly

Abstract

ObjectiveTransradial angiography has become popular among many cardiologists as a diagnostic and therapeutic tool. However, transradial cerebral angiography is not utilized to the same extent. The purpose of this study is to present our experience regarding the usefulness of transradial cerebral angiography, especially in elderly patients.MethodsBetween May 2011 and February 2012, a total of 126 cerebral angiographies were performed via a transradial approach in a single center. Of them, only 47 patients were over 60 years old. In our institution, we shifted the initial access from the right femoral artery to the right radial artery in all patients requiring cerebral angiography in 2011. We did not attempt radial access in 40 cases for variable reasons.ResultsThe procedural success rate was 92.2%. We have four failures of transradial angiography; two because of loop formations of the radial and brachial artery and two due to multiple puncture failures. All supra-aortic vessels were successfully catheterized. However, the selective catheterization rates of the left side distal vessels were lower, as success rates were 89.7% for the right internal carotid artery and 75% for the left internal carotid artery. Procedure-related vascular complications, such as puncture site hematoma, hand ischemia, pseudoaneurysm, arteriovenous fistula and arterial dissection were not observed in our series. However, intraprocedural thrombosis developed in one patient, which was resolved completely by intraarterial thrombolytic agents.ConclusionWith advancing patient's age, we believe that transradial cerebral angiography is a useful tool to decrease patient's discomfort and more effectively manage the vessel tortuosity.

Effectiveness of a handmade “New Carotid Catheter” in transradial carotid angiography: A comparison with conventional multipurpose catheters

“…For this reason, we chose not to compare the new catheter design with a Simpson catheter but rather with the 3.5 JL catheter that we have routinely used. 19,22,24 Even though transradial carotid visualization can be achieved using standard catheters, carotid arteries cannot be selectively cannulated, and the images obtained are far from satisfactory compared with the selective images. The size and track of the plaque, in particular, cannot be clearly evaluated.…”

“…The use of these catheters increased the success rate of coronary visualization. However, a catheter has not yet been designed for the assessment of carotid arteries …”

“…The retroflexed tip of the 3.5 JL catheter provides improved cannulation of the left common carotid artery and is one of the most frequently available catheters in every laboratory. For this reason, we chose not to compare the new catheter design with a Simpson catheter but rather with the 3.5 JL catheter that we have routinely used …”

The Role of Catheter Reshaping at the Angiographic Success

“…Therefore, performing selective angiography with a Simpson catheter requires special experience and manual dexterity. The retroflexed tip of the 3.5 JL catheter provides improved cannulation of the left common carotid artery and is one of the most frequently available catheters in every laboratory [9][10][11]16].…”

“…Invasive imaging is still the gold standard in neck malformations, carotid tumors, neck injuries, and carotid artery stenosis. In still today, cardiovascular surgeons, neurologists, and neurosurgeons, if they see lesions in the carotid artery at the MR and CT angiography, require invasive carotid angiography when they propose an additional intervention for these lesions [9,10,[12][13][14][15][16][17][18].…”