Navigating radial artery loops in neurointerventions

Luther, Evan; Burks, Joshua D.; Abecassis, Isaac J.; Nada, Ahmed; Heath, Rainya; Berry, Katherine; McCarthy, David; Saini, Vasu; Silva, Michael; Huang, Eric Yi-Hsiu; Strickland, Allison; Yavagal, Dileep R.; Peterson, Eric C.; Levitt, Michael R.; Starke, Robert M.

doi:10.1136/neurintsurg-2020-016856

Cited by 22 publications

(19 citation statements)

References 30 publications

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“…During the study period, our institution switched to a radial-first approach, which has been associated with a lower risk of complications compared with traditional femoral access, consequently making MMA embolization safer 19–27. In our study, 65 of the 84 cSDHs (77%) were treated via radial access with no major complications.…”

Section: Discussionmentioning

confidence: 79%

Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization

Catapano

Ducruet

Srinivasan

et al. 2021

J NeuroIntervent Surg

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BackgroundFew reports discuss variables associated with improved outcomes after middle meningeal artery (MMA) embolization for chronic subdural hematomas (cSDHs). We analyzed radiographic evidence of cSDH clearance after MMA embolization to elucidate optimal techniques, hematoma clearance rates, and suitable length of follow-up.MethodsPatients who underwent MMA embolization for cSDH from January 1, 2018 through December 31, 2020 were analyzed. Patient characteristics, demographics, and technical procedural details were examined. Outcomes for cSDHs analyzed included complete or near-complete resolution at 30, 90, and 180 days following embolization. A multivariable logistic regression analysis identified variables predictive of rapid clearance and resolution of hematomas at 90 days.ResultsThe study cohort comprised 66 patients with 84 treated cSDHs. The mean (SD) cSDH size differed significantly at 30-day (8.8 (4.3) mm), 90-day (3.4 (3.0) mm), and 180-day (1.0 (1.7) mm) follow-up (p<0.001). More cSDHs had complete or near-complete resolution at 180 days (92%, 67/73) than at 90 (63%, 45/72) and 30 days (18%, 15/84) post-embolization (p<0.001). Only distal embolysate penetration was independently associated with rapid clearance (OR 3.9, 95% CI 1.4 to 11.1; p=0.01) and resolution of cSDHs at 90 days (OR 5.0, 95% CI 1.7 to 14.6; p=0.003).ConclusionAlthough 63% of cSDHs with MMA embolization had complete or near-complete resolution by 90 days post-procedure, 92% reached this stage by 180 days. Therefore, 90-day follow-up may be insufficient to determine the effectiveness of MMA embolization for cSDHs, particularly compared with surgical evacuation alone. Also, distal MMA penetration may be associated with more rapid hematoma clearance.

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Section: Discussionmentioning

confidence: 79%

Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization

Catapano

Ducruet

Srinivasan

et al. 2021

J NeuroIntervent Surg

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“…An important distinction is that a brachioradial artery is a high origin of the main radial artery trunk from the brachial or axillary artery, while the accessory or recurrent radial artery with a radial loop is a branch from the radial artery that typically originates around the forearm at the proximal radial artery and can course in parallel to the brachial artery toward the axilla. Importantly, an accessory radial artery is associated with a high risk of severe spasm and should not be catheterized 14 36…”

Section: Discussionmentioning

confidence: 99%

“…Transradial artery access (TRA) continues to gain widespread acceptance for various neurointerventional procedures 1–20. However, as TRA use for neurointerventional procedures has increased, there has been an increase in complications that were previously rarely encountered 18.…”

Section: Introductionmentioning

confidence: 99%

Retained radial catheters associated with variant radial anatomy in neurointerventional procedures

Catapano

Winkler

Srinivasan

et al. 2022

J NeuroIntervent Surg

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BackgroundTransradial artery access (TRA) for neurointerventional procedures is gaining widespread acceptance. However, complications that were previously rare may arise as TRA procedures increase. Here we report a series of retained catheter cases with a literature review.MethodsAll patients who underwent a neurointerventional procedure during a 23-month period at a single institution were retrospectively reviewed for a retained catheter in TRA cases. In cases of retained catheters, imaging was reviewed for anatomical variances in the radial artery, and clinical and demographic case details were analyzed.ResultsA total of 1386 nondiagnostic neurointerventional procedures were performed during the study period, 631 (46%) initially via TRA. The 631 TRA cases were performed for aneurysm embolization (n=221, 35%), mechanical thrombectomy (n=116, 18%), carotid stent/angioplasty (n=40, 6%), arteriovenous malformation embolization (n=38, 6%), and other reasons (n=216, 34%). Thirty-nine (6%) TRA procedures crossed over to femoral access, most commonly because the artery of interest could not be catheterized (26/39, 67%). A retained catheter was identified in five cases (1%), and one (0.2%) patient had an entrapped catheter that was recovered. All six patients with a retained or entrapped catheter had aberrant radial anatomy.ConclusionRetained catheters for neurointerventional procedures performed via TRA are rare. However, this complication may be associated with variant radial anatomy. With the increased use of TRA for neurointerventional procedures, awareness of anatomical abnormalities that may lead to a retained catheter is necessary. We propose a simple protocol to avoid catheter entrapment, including in emergent situations such as TRA for stroke thrombectomy.

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“…Clinical RAS refers to arterial spasm that required an intervention to combat it. 6,7 Right TRA Techniques…”

Section: Inclusion Criteria and Definition Of Variablesmentioning

confidence: 99%

“…17,18 After the sheath has been placed and back bled, radial angiography is performed in all cases to evaluate the anatomy before advancing any system into the sheath. 6 The radial artery diameter was measured angiographically just distal to the sheath on the angiogram.…”

Section: Inclusion Criteria and Definition Of Variablesmentioning

confidence: 99%

Transradial Access Failures During Neuroangiography for Patients With Moyamoya

et al. 2023

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BACKGROUND: Despite studies continuing to demonstrate the utility of transradial access (TRA) in neuroangiography, minimal data exist regarding predictors of TRA failure. Furthermore, although many patients with moyamoya disease/syndrome will require life-long angiographic evaluation, even less has been reported on the usage of TRA in this population. OBJECTIVE: To perform a matched analysis at our high-volume moyamoya center to determine predictors of TRA failure in these patients. METHODS: A total of 636 patients undergoing TRA for neuroangiography were identified from 2018 to 2020. Demographic and angiographic characteristics including radial artery spasm (RAS), radial anomalies, and access site conversion were compared between patients with moyamoya and the rest of the cohort. A 4:1 matched analysis, based on age and sex, was also performed to eliminate confounding variables. RESULTS: Patients with moyamoya were younger (40 vs 57 years, P < .0001), had smaller radial diameters (1.9 vs 2.6 mm, P < .0001), more commonly had a high brachial bifurcation (25.9% vs 8.5%, P = .008), more frequently experienced clinically significant RAS (40% vs 8.4%, P < .0001), and more often required access site conversion (26.7% vs 7.8%, P = .002). Increasing age was associated with less TRA failures in patients with moyamoya (odds ratio = 0.918) but more failures in the rest of the cohort (odds ratio = 1.034). In the matched analysis, patients with moyamoya continued to experience more radial anomalies, RAS, and access site conversions. CONCLUSION: Patients with moyamoya, when controlling for age and sex, have higher rates of TRA failure during neuroangiography. Increasing age in Moyamoya is inversely correlated with TRA failures suggesting that younger patients with moyamoya are at higher risk of extracranial arteriopathy.

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Navigating radial artery loops in neurointerventions

Cited by 22 publications

References 30 publications

Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization

Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization

Retained radial catheters associated with variant radial anatomy in neurointerventional procedures

Transradial Access Failures During Neuroangiography for Patients With Moyamoya

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