Transradial Approach for Neuroendovascular Procedures: A Single-Center Review of Safety and Feasibility

Abstract

BACKGROUND AND PURPOSE:In recent years, the transradial approach has become more widely adopted for neuroendovascular procedures. The purpose of this study was to evaluate the safety and feasibility of a transradial approach and distal transradial access for neuroendovascular procedures in a single center. MATERIALS AND METHODS:Retrospective analysis was performed for all patients who underwent transradial approach or distal transradial access neuroendovascular procedures from January 2016 to August 2019 at a single center. Exclusion criteria included a Barbeau D waveform, a radial artery of ,2 mm on sonographic evaluation, and known radial artery occlusion. Procedures were evaluated for technical success (defined as successful radial artery access and completion of the intended procedure without crossover to an auxiliary access site), complications, and adverse events during follow-up at 30 days. RESULTS:The transradial approach or distal transradial access was attempted in 279 consecutive patients (58.1% women; median age, 57.7 years) who underwent 328 standard or distal transradial approach procedures. Two-hundred seventy-nine transradial approach and 49 distal transradial approach procedures were performed (cerebral angiography [n ¼ 213], intracranial intervention [n ¼ 64], head and neck intervention [n ¼ 30], and stroke intervention [n ¼ 21]). Technical success was 92.1%. Immediate adverse events (2.1%) included radial access site hematoma (n ¼ 5), radial artery occlusion (n ¼ 1), and acute severe radial artery spasm (n ¼ 1). Thirty-day adverse events (0.3%) included a radial artery pseudoaneurysm (n ¼ 1). Twenty-six cases (7.9%) required crossover to transfemoral access. CONCLUSIONS:The transradial approach for neuroendovascular procedures is safe and feasible across a wide range of neuroendovascular interventions.

Initial Experience Using the Transradial Approach for Endovascular Treatment of Vascular Pathologies: Safety and Feasibility

“…The TRA has gained widespread acceptance among neurosurgeons and neurointerventionists due to its demonstrated safety and efficacy for treatment of neuroendovascular procedures. 4 5 6 7 10 Despite a substantial learning curve is mandatory and requires 30 to 50 angiographies to master the technique, 11 several advantages over the classic TFA have been reported such as patient satisfaction, lower morbidity, and less hospital length of stay. 3 In this initial experience, we demonstrated that this approach is safe and feasible and permitted an appropriate treatment of intracranial aneurysms and vascular malformations without access-related complications and without catheter navigation-related difficulties.…”

“…The navigation of a 6-F Benchmark 071 (Penumbra) guide catheter accompanied by the 5F Select Simmons (Penumbra) catheter is an ideal combination to gain access to the selected intracranial arteries without catheter exchange. 6 10 However, the Select Simmons catheter is not available in our institution.…”

“…4 On the other hand, the transition to TRA is somehow difficult to achieve due to the preferences of the TFA and the familiarity with this approach, requiring a consecutive number of procedures to master the technique. [5][6][7] In addition, few papers reporting the TRA for treatment have been reported in Latin America, demonstrating that the transition to the TRA has certain limitations in some countries, especially in this region. 8,9 Our study aimed to focus on the initial experience in the implementation of the TRA for the endovascular treatment of vascular pathologies and to determine its safety and feasibility.…”

“… 4 On the other hand, the transition to TRA is somehow difficult to achieve due to the preferences of the TFA and the familiarity with this approach, requiring a consecutive number of procedures to master the technique. 5 6 7 …”

Transbrachial access for mechanical thrombectomy in a case of acute ischemic stroke with aortic bifurcation occlusion

“…1 Common femoral artery is the routine access site; however, recently radial and brachial accesses are becoming more popular. [2][3][4][5] Transradial access has already become routine for coronary interventions. 6 Neurointerventionalists are also gradually shifting toward these alternate access sites because of less incidence of complications and better patient satisfaction.…”