Transradial intraoperative cerebral angiography: a multicenter case series and technical report

Abstract

BackgroundUse of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative cerebral angiography.ObjectiveTo report a multicenter experience on the use of radial artery access in intraoperative cerebral angiography, including case series and discussion of technical nuances.Methods27 patients underwent attempted transradial cerebral angiography betweenMay 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications.Results24 of the 27 patients (88.8%) underwent successful transradial intraoperative cerebral angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication.ConclusionsTransradial intraoperative cerebral angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.

The Effects of Diagnosis-Related Group Payment on Diagnostic Cerebral Angiograms through a Transradial and Transfemoral Approach: A Comparative Observational Study

“…We know that DRG payment is to divide patients into different groups and formulate different payment standards for different groups [1], which has a significant impact on improving medical efficiency, reducing hospitalization costs, and shortening the length of stay. Although there are no comparative statistics on the length of stay and cost of the two approaches for cerebral angiography, there have been many statistical studies on the comparison of these two different approaches in terms of coronary intervention treatment [17][18][19]. e hospitalization time and cost for patients undergoing interventional therapy via the radial artery approach are less than for patients who choose the femoral artery approach [17,20].…”

Trans-radial cerebral angiography-safety, efficacy and patient comfort: review of literature

“…32 Causes of failure and technical difficulties that might necessitate a cross-over to the femoral access include severe vasospasm (prohibiting the advancement of the catheter despite adequate vasolytic medication), inadvertent entry into the venous system, radial artery loop, radial artery extravasation, radial artery tortuosity, Arteria Lusoria, left common carotid artery tortuosity, bovine aortic arch, spinal angiogram, large body habitus (prevents adequate visualisation of the major vessels) and failure to form the Simmons catheter. 8,32 COMPLICATIONS Some of the observed complications include excessive bleeding, large hematoma formation, pseudoaneurysm needing additional closure, arteriovenous fistula, arterial dissection, ischemic limb needing surgery, radial artery extravasation, abscess, retroperitoneal hemorrhage, stroke and/or death. 8,9,32…”

“…This was because of the perception that the TFA confers better work-flow ergonomics, ease of catheterizing the target vessel, the larger calibre of the femoral artery allowing the usage of a broader range of instrumentation, lower chances of vessel spasm necessitating a cross-over procedure and familiarity attained through prior experience. 8 However, the TFA is associated with some snags such as greater puncture site complications, lying supine with a straight leg for 2-8 hours, pain, all of which contribute to patient discomfort.…”

#RadialFirst and #RadialForNeuro: A descriptive analysis of Twitter conversations regarding transradial access

“…Radial access is rapidly emerging as a safe and effective alternative to the transfemoral approach within neurointerventional surgery. [1][2][3][4] This method was pioneered within cardiovascular intervention, as it provided comparable diagnostic and therapeutic technical success, and was associated with fewer access-site related complications than femoral access. 5 A 2018 Cochrane review of 31 interventional cardiology randomized controlled trials concluded that transradial access reduced death from cardiac causes, 30 day all-cause mortality, bleeding, local access-site complications, and hospital length of stay.…”

“…6 In neurointerventional surgery, various institutional and multicenter studies have recently corroborated similar safety, feasibility, and clinical benefits of radial catheterization for cerebral and spinal angiography, stroke rescue, tumor embolization, and treatment of aneurysms, arteriovenous fistulas, and vascular malformations. [1][2][3][4][7][8][9][10][11][12] The ability to perform transradial catheterization is an important tool to have in a neurointerventional armamentarium. The speed of technique adoption within the field will in part be dependent upon the growing pool of evidence for transradial access efficacy, and the rate of information dissemination.…”