Improved Fluoroscopy and Time Efficiency with Radial Access for Diagnostic Cerebral Angiography

Abstract

BACKGROUND AND PURPOSE Radial artery catheterization has been newly incorporated into the field of endovascular surgical neuroradiology as a safer and more efficient method for Cerebral angiography as opposed to the femoral artery approach. The objective is to understand the relationship between cerebral angiography procedure times after an operator has converted to a radial first approach. METHODS A retrospective analysis was conducted from January to August of 2019 to compare procedural times for femoral and radial artery approaches. This was conducted by comparing different procedural specifications, such as total procedural time, fluoroscopy time, and amount of contrast used. RESULTS The average age of the 434 patients in the analysis was 63.9 years with a range of 19 and 96 years. One hundred eighty‐three patients (mean fluoroscopy time 7.55, 95% confidence interval 7.03‐8.08) underwent successful diagnostic cerebral angiographies through the radial artery and, 251 patients through the femoral approach. The first 2 months of the radial approach saw an average fluoroscopy time of 11.23 minutes. In the last 2 months of the study, the fluoroscopy time plateaued to an average of 6.73 minutes after 55 cases. Radial artery average procedural time was reduced from 33 to 21 minutes. Angiography utilizing the femoral approach averaged 16 minutes throughout the study period. CONCLUSION Transradial procedural time and fluoroscopy time continued to improve until about 55 cases, but did not reach the peak efficiency of the femoral approach. Further advances in catheter technology are needed to continue to improve radial artery diagnostic cerebral angiography.

Adapting to transradial approach in cerebral angiography: Factors influencing successful cannulation

“…In the first eight cases, it took 28–35 min, but after 21 cases, it took 10.2–18 min. In comparison to the earlier study by Kenawy et al, 16 this was slightly higher. However, as compared to their study, our sample size was substantially smaller.…”

Multimodal imaging approach for the diagnosis of intracranial atherosclerotic disease (ICAD): Basic principles, current and future perspectives

“…DSA is also associated with a minimal, but not unheard of, risk of embolic stroke or vascular dissection(0.5%) resulting in transient neurological deficit (0.5%) or even permanent disability (0.7%), radiation exposure, contrast allergy (0.5%), access sites hematoma (4%), and acute kidney injury. 19,20 These complications are rare but do occur often in older patients with cardiovascular risk factors, challenging tortuous anatomy such as a type 3 arch, or if the fluoroscopic time is longer than 10 min 21 and tend to occur less with more experienced operators. 22 Improvements in techniques such as using radial access make complications like a life-threatening retroperitoneal hematoma almost nonexistent.…”