The Benefits can be Achieved after the Shift from Transfemoral Access to Transradial Access in Cerebral Angiography

Abstract

Departmental sources Background: Cerebral angiography, or intra-arterial digital subtraction angiography (DSA), is a fluoroscopic imaging technique. In China, until recently, transfemoral access (TFA) has been used, rather than transradial access (TRA). This retrospective study aimed to compare transfemoral cerebral angiography (TFCA) with transradial cerebral angiography (TRCA) consecutively performed by the same operator, at a single center in China, to determine whether there were benefits from the shift from TFA to TRA in terms of efficiency, safety, and feasibility. Material/Methods: A review of 1,048 cerebral angiograms in 980 patients was performed by a single operator from June 2014 to May 2018, including the TFA group (n=513) and the transradial access (TRA) group (n=535), and 39 patients underwent both TFA and TRA. The total procedure time, duration of fluoroscopy, catheterization success rate, image quality, length of stay in hospital, complications of the procedure, and patient preference were compared between the groups. Results: Compared with TFCA, TRCA resulted in significantly shorter total procedure time, a higher catheterization success rate, better image quality, and shorter duration of hospital stay (P<0.05). There was no significant difference between the TFA and TRA groups for cardiovascular, cerebral, and access site complications. Patients in the TRA group showed a significantly reduced fluoroscopy time at the early stages of operator training (P<0.05). Patient preference included TRA (76.74%), TFA (16.28%), and no preference (6.89%). Conclusions: During four years at a single center, and with a single operator, TRCA was safe, feasible, and more rapid when compared with TFCA.

Trans-radial versus trans-femoral approach for cerebral angiography: a meta-analysis of randomized controlled trials.

“…In individuals with complex aortic arch anatomy such as individuals with bovine or type III arches, angiographic procedures are often longer and entail a higher risk of embolic events with the potential to cause neurological damage [ 22 ]. One retrospective analysis of 535 individuals with bovine or type III arches found the TRA to be associated with significantly higher successful catheterization rates in the right common carotid artery, right subclavian artery, and left vertebral artery relative to the TFA [ 21 ]. The TRA has also been reported to offer advantages with respect to carotid stent placement in patients with bovine arch [ 23 ], with a reported 100% procedural success rate in 16 individuals with bovine or type III aortic arches undergoing TRA-based carotid stenting having been reported by Dahm et al .…”

“…Successful cerebral angiography was defined by a single operator having successfully completed bilateral common carotid and vertebral angiography scans without the need to cross over to an additional access site [ 16 ]. Puncture time was the interval between initial puncture and successful introducer sheath placement [ 21 ]. Operative duration was the interval from arterial puncture to final closure [ 21 ].…”

“…Puncture time was the interval between initial puncture and successful introducer sheath placement [ 21 ]. Operative duration was the interval from arterial puncture to final closure [ 21 ]. Fluoroscopic duration was measured as a surrogate readout for radiation exposure during angiographic analysis [ 21 ].…”

“…Operative duration was the interval from arterial puncture to final closure [ 21 ]. Fluoroscopic duration was measured as a surrogate readout for radiation exposure during angiographic analysis [ 21 ].…”

Therapeutic efficacy and complications of radial versus femoral access in endovascular treatment of unruptured intracranial aneurysms

“…[1][2][3][4][5][6][7][8][9][10] On the other hand, compared with TFA, TRA has been shown to have the following drawbacks: increased radiation exposure due to prolonged operation time; 8 difficulty performing the procedure for anatomic reasons; 4 a lack of TRAspecific devices; and the need for proficiency in the procedure. 2,[11][12][13][14] However, the majority of the literature comparing TRA and TFA is based on reports of diagnostic cerebral angiography, [15][16][17][18][19][20][21] carotid stenting, [22][23][24] vertebral and basilar artery stenting, 25 mechanical thrombectomy, [26][27][28][29] and flow diversion, 30,31 with few studies on intracranial aneurysms.…”