Left transradial access for cerebral angiography

Abstract

IntroductionTransradial access is increasingly used among neurointerventionalists as an alternative to the transfemoral route. Currently available data, building on the interventional cardiology experience, primarily focus on right radial access. However, there are clinical scenarios when left-sided access may be indicated. The purpose of this study was to evaluate the technical feasibility of left transradial access to cerebral angiography across three institutions.MethodsA retrospective chart review was performed for patients who underwent cerebral angiography accessed via the left radial artery at three institutions between January 2018 and July 2019. The outcome variables studied were successful catheterization, vascular complications, and fluoroscopic time.ResultsNineteen patients underwent a total of 25 cerebral angiograms via left transradial access for cerebral aneurysms (n=15), basilar occlusion (n=1), carotid stenosis (n=1), arteriovenous malformation (n=1), and cervical neurofibroma (n=1). There were 12 diagnostic angiograms and 13 interventional angiograms. The left transradial approach was chosen due to left vertebrobasilar pathology (n=22), right subclavian stenosis (n=2), and previous right arm amputation (n=1). There was one instance of radial artery spasm, which resolved after catheter removal, and one conversion to transfemoral access in an interventional case due to lack of distal catheter support. There were no procedural complications.ConclusionsLeft transradial access in diagnostic and interventional cerebral angiography is a technically feasible, safe, and an effective alternative when indicated, and may be preferable for situations in which pathology locations or anatomic limitations preclude right-sided radial access.

Mechanical Thrombectomy in Patients With Acute Ischemic Stroke: A Comparison of Transradial Versus Transfemoral Cerebral Angiography

“…Access through the transradial route had a vascular complication rate of 0.1%-0.2% [18,19]. Other complications that commonly occur with the transradial approach include asymptomatic temporary or permanent radial arterial occlusion, which has an occurrence rate of 5%.…”

“…The advantages and disadvantages of TFA and TRA in acute ischemic stroke are summarized in Table 2 [18,19,25].…”

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

“…Although left TRA is rarely reported for cerebral angiography, interventional cardiologists have reported extensive experience. The most commonly perceived pitfalls for left transradial access include increased procedural time and operator discomfort (Barros et al 2020 ). In our sample, left-sided radial access was preferred in posterior circulation or in case of right puncture failure; crossing over the left radial artery may contributed to reduce the number of cases converted in TFA (3,2%) in comparison to other published studies (4,7%- 24,8%) (Almallouhi et al 2020 ; Snelling et al 2018b ; Joshi et al 2020 ).…”

Radial artery access anatomy: considerations for neuroendovascular procedures

“…Although the figures used throughout this review illustrate right sided anatomy as the default access option, left sided access is feasible with proper room setup depending on the patient's anatomy. 29 The radial artery continues in the same direction as its parent trunk and extends from the cubital fossa to the palm, ending as an anastomosis with the ulnar artery to form the deep palmar arch, as described above.…”