Exploring the path less traveled: Distal radial access for diagnostic and interventional neuroradiology procedures

Manzoor, Muhammad; Al‐Rashed, Abdullah A.A.A.; Almulhim, Ibrahim A.; Althubait, Shorog; Alqahtani, Sultan; Al-Senani, Fahmi; Alturki, Abdulrahman Y.

doi:10.1016/j.jocn.2021.06.014

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…1)2) Vasospasm and radial artery occlusion are other pertinent disadvantages of TRA. 9) Ulnar artery is the companion forearm artery with similar advantages as TRA. However, due to its deeper location and steeper learning curve, it is scarcely used as a primary access for endovascular procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The main limitation of this access site is relatively small size of the artery, which can limit the type of equipment used for mechanical thrombectomy procedures [ 1 , 2 ]. Vasospasm and radial artery occlusion are other pertinent disadvantages of TRA [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although, alternate access routes bypass certain anatomic hurdles, they can pose inherent challenges. Recently, trans-ulnar access (TUA) has been described as a safe and feasible alternate option for neurointerventional procedures [ 9 ]. Although various procedures have been performed via this approach, no previous case of intracranial mechanical thrombectomy procedure utilizing this access is described in literature.…”

Section: Introductionmentioning

confidence: 99%

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Ulnar artery access for intracranial mechanical thrombectomy procedure: A salvage option after failed trans-femoral and trans-radial access

Manzoor

Al‐Rashed

Almulhim

et al. 2023

J Cerebrovasc Endovasc Neurosurg

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84 years old gentle man with past medical history of hypertension and diabetes presented with sudden onset right sided weakness and aphasia for two hours. Initial neurological assessment revealed National Institute of Health Stroke Scale (NIHSS) 17. Computed tomography (CT) scan demonstrated minimal early ischemic changes along left insular cortex with occlusion of left middle cerebral artery (MCA). Based on clinical and imaging findings, decision was made to perform mechanical thrombectomy procedure. Initially, right common femoral artery approach was utilized. However, due to unfavorable type-III bovine arch, left internal carotid artery could not be engaged via this approach. Subsequently, access was switched to right radial artery. Angiogram revealed small caliber radial artery, with larger caliber ulnar artery. Attempt was made to advance the guide catheter through the radial artery, however significant vasospasm was encountered. Subsequently, ulnar artery was accessed and successful thrombolysis in cerebral infarction (TICI) III left MCA reperfusion was achieved with a single pass of mechanical thrombectomy via this approach. Post procedure neurological examination demonstrated significant clinical improvement. Doppler ultrasound 48 hours after the procedure demonstrated patent flow in radial and ulnar arteries with no evidence of dissection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ulnar artery access for intracranial mechanical thrombectomy procedure: A salvage option after failed trans-femoral and trans-radial access

Manzoor

Al‐Rashed

Almulhim

et al. 2023

J Cerebrovasc Endovasc Neurosurg

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“…Several studies have reported the use of the DRA in neuroendovascular treatment, as shown in Table 3. [17][18][19][20][21][22][23][24][25] The DRA has been used to treat various diseases, including aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistulas, carotid artery stenosis, and acute cerebral infarction. The guiding sheath is selected from amongst 4-to 6-Fr systems, except for one case where a 7-Fr system was used.…”

Section: Discussionmentioning

confidence: 99%

Distal radial artery approach is safe and effective for cerebral angiography and neuroendovascular treatment: A single-center experience with ultrasonographic measurement

et al. 2022

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Background The transradial artery approach to cerebral angiography can reduce both patient stress following examination and the risk of major complications due to hematoma. Recently, the distal radial artery approach (DRA) has garnered attention in cardiology as a minimally invasive method. DRA is also considered applicable to neurosurgery, although concerns about procedural difficulty and complications persist. Therefore, this study aimed to evaluate the efficacy of the DRA in cerebral angiography and neuroendovascular treatment. Methods We retrospectively selected 30 consecutive patients for whom the DRA was attempted for cerebral angiography at our hospital. The patients’ age, sex, height, weight, and medical history information was collected and correlated with successful puncture and complications. The diameter of the distal radial artery (RA) was measured using ultrasonography. Results The median patient age was 67 years (range, 32–87 years) and 21 (70%) were men. The median diameter of the distal RA was 2.3 mm (range, 1.7–3.2 mm). Distal RA puncture was successful in 23 patients (77%) and no complications were noted; however there was no significant correlation between successful puncture and any of the patient factors. Carotid artery stenting and preoperative tumor embolization were performed via DRA in six and three cases, respectively. Although puncture site hematoma occurred in only one case, all treatments were successful, and no major complications were observed. Conclusion DRA can be safely used for cerebral angiography and neuroendovascular treatment.

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“…63 The neuroradiology field has also adopted this approach. 64 A special role is played by the recanalization of the radial forearm artery (post-PCI RAO) and the continuation of the coronary procedure through the same ipsilateral approach. DRA can therefore reopen the jeopardized radial artery.…”

Section: Distal Radial For Peripheral Interventionsmentioning

confidence: 99%

The distal radial artery: Versatile vascular access for transcatheter interventions

Achim

Ruzsa

2022

J Vasc Access

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Conventional transradial access has been established as the gold standard for invasive coronary angiography and percutaneous interventions by the current European and American guidelines. The distal or snuffbox radial artery access represents an alternative transradial access site that allows radial sheath insertion with the patient’s hand pronated. Firstly described 40 years ago, it exploded in popularity only recently. Promising additional benefits, the distal radial access is increasingly being adopted in various types of percutaneous interventions, being preferred by many interventional cardiologists and radiologists for its reduced vascular complications and time to hemostasis, and improvement of patient and operator comfort. Other centers consider it a fad, waiting for solid clear evidence and benefits. The evidence is dynamic and discrepant, depending on the center, the operator, and how it was collected (randomized controlled vs observational studies). Another essential aspect raised by “skeptics” was whether distal radial access, by its smaller diameter and more angled course, can support all types of interventions. The aim of this review is to gather all the scenarios where distal radial access has been utilized and to conclude whether this vascular access is feasible across all transcatheter interventions.

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Exploring the path less traveled: Distal radial access for diagnostic and interventional neuroradiology procedures

Cited by 7 publications

References 24 publications

Ulnar artery access for intracranial mechanical thrombectomy procedure: A salvage option after failed trans-femoral and trans-radial access

Ulnar artery access for intracranial mechanical thrombectomy procedure: A salvage option after failed trans-femoral and trans-radial access

Distal radial artery approach is safe and effective for cerebral angiography and neuroendovascular treatment: A single-center experience with ultrasonographic measurement

The distal radial artery: Versatile vascular access for transcatheter interventions

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