Feasibility of the Transradial or the Transbrachial Approach in Various Neurointerventional Procedures

Abstract

PurposeThe generally preferred vascular access for neurointerventional procedures is the transfemoral approach (TFA). In complicated cases such as patients with aortic diseases or tortuous vessels, transradial or transbrachial approaches (TRA or TBA) could be good alternatives. The purpose of this study is to review a single medical center experience using the alternative accesses.Materials and MethodsWe reviewed the medical records of 30 TRA and 10 TBA cases among 2,073 cases treated between January 2010 and July 2013. We reviewed and analyzed the frequency of TRA and TBA, the reason the operator had chosen the TRA or TBA, the category of the procedure, caliber of the sheath, the success rate, and the complications rates.ResultsThe most common reason the non-TFA route was chosen was due to the patient's tortuous vascular system (n=24, 60%). The most common category of intervention was balloon angioplasty and/or stent placement (n=18, 45%). The largest caliber of the introducing sheath was 6 Fr in TRA and 7 Fr in TBA. Procedural success was achieved in 37 cases (success rate: 92.5%), and in three cases it failed. Six patients with complications were reported. Among them, four cases of minor complications (10%) occurred. There was no serious complication directly related to the access problem.ConclusionBoth TRA and TBA can be good alternative access routes when TFA is not appropriate in various neurointervential procedures.

Transradial approach for neurointerventions: a systematic review of the literature

“…The location of the lesion was described as an anterior or posterior circulation lesion in 955 cases, of which 816 (85.44%) were located in the anterior circulation and 121 (14.55%) were located in the posterior circulation. The studies included are described in table 1 7–27…”

Direct Brachial Approach for Acute Basilar Artery Occlusion: Technical Note and Preliminary Clinical Experience

“…In this study, the DiBA technique was successfully used to navigate a guide catheter to a targeted vessel in all 4 patients. Lee et al 13 reported their clinical experience of neurointerventional procedures via the transbrachial and transradial approaches. They mentioned the superiority of transbrachial or transradial approach to bypass the tortuosity of the aorta and the iliac artery.…”

“…They mentioned the superiority of transbrachial or transradial approach to bypass the tortuosity of the aorta and the iliac artery. 13 In 2018, Ishikawa et al 14 previously reported a technique that was similar to the DiBA technique. In that approach, ADAPT (a direct aspiration first pass technique) 15 was initially performed on both the anterior and posterior circulation.…”

Recommendations for Endovascular Care of Stroke Patients

“…Although the femoral approach is the most common and preferred method of accessing cerebral vessels, the vasculature of patients may impede the ability to use the femoral artery. When the patient has a tortuous vasculature in the lower extremities, the radial and/or brachial arteries are often considered a good alternative to the femoral artery [41]. If the vertebral artery is the target vessel, the radial approach will be beneficial for quicker access [42].…”

“…The radial artery approach for endovascular therapy has advantages and disadvantages, which are detailed in Table 17 [41,42]. Hemostasis after radial approach is achieved using two different methods: manual compression or a compression device [42].…”