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E-062 transradial access for acute interventional stroke therapy
  1. J Farkas1,
  2. K Sivakumar2,
  3. T Sabharwal2,
  4. H Dababneh2,
  5. A Tiwari2,
  6. K Arcot2
  1. 1Neuroradiology, Lutheran Medical Center, Brooklyn, NY, USA
  2. 2Neurology, Lutheran Medical Center, Brooklyn, NY, USA

Abstract

Introduction Mechanical thrombectomy for acute stroke therapy is the new standard of care. Interventionalists may encounter difficulty using femoral access such that another option is needed. Transradial access can be of a benefit in difficult cases. Such cases include, advanced age, anatomic variations such as a bovine arch, posterior circulation stroke, severe aortic arch unfolding, morbid obesity and severe femoral disease (leading to increased risks of transfemoral catheterization). We are reporting our single center experience with transradial access for acute ischemic stroke therapy.

Methods and materials We retrospectively reviewed our stroke interventional database (January 2013–March 2015) for all patients who underwent endovascular mechanical thrombectomy for acute ischemic stroke using a transradial approach. We included all patients where primary or secondary transradial access was attempted to gain access to the intracranial circulation.

The interventionalist performs a modified Allen’s test followed by micropuncture needle access and administration of a prophylactic cocktail of verapamil 5mg, heparin 1000 units, and nitroglycerin 200ug through the sheath. Under fluoroscopy, a 3mm J-wire is placed into the radial artery and advanced into the subclavian artery. A NeuronMax-088 sheath (©Penumbra, Irvine CA) is then inserted. A short 5F sheath is only used if wire advancement is difficult. Obstruction due to a loop or severe angulation can be resolved with road mapping, glide wire, diagnostic catheter and sheath exchange over an Amplatz wire. The sheath is advanced into the right subclavian and kept proximal to the vertebral origin. Depending on the target vessel there are several techniques available to engage the required vessel.

Results We Identified 19 patients as having transradial access for thrombectomy following acute stroke. Patient ages ranged 40–92 years of age with a mean of 81.42 (±13.82). In patients with Primary attempts time from radial puncture to clot engagement ranged from 7–46 mins with a mean of 26.7 min (±13.1). In 16/19 patients successful catheterization of the target vessel was accomplished using the transradial approach. In 3 patients transradial axis was not successful due to tortuous anatomy, poor vessel caliber and upstream occlusion.

Conclusion Transradial artery access for neuro-interventional procedures is rarely considered today. Our small case study suggests that transradial access is safe and efficacious in advance stroke therapy. Further studies with larger sample size are needed.

Disclosures J. Farkas: None. K. Sivakumar: None. T. Sabharwal: None. H. Dababneh: None. A. Tiwari: None. K. Arcot: None.

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