Abstract

The transradial access route for intervention has become routine in cardiology practice but has seen limited application in neurointervention. The transradial route benefits include lower risk of bleeding, less patient discomfort during the recovery phase and provides a safer alternative to brachial arteriotomy when the femoral access route is not available. To date limited series of neuroendovascular treatments using radial access have been reported, mostly at academic centers. This presentation summarizes a single operator experience in a community hospital setting employing a ‘radial first’ approach to perform >50 neurointerventional procedures during an 8 month period from July 2017 to present. Patients were screened in advance for adequate collateral circulation using the Barbeau test. Interventions included aneurysm embolization (36, 15 with Pipeline flow diverter), intracranial and head/neck AVM embolization (4), intracranial stent/angioplasty for symptomatic intracranial atherosclerosis (4), preoperative tumor embolization (2), vasospasm treatment (2), extracranial carotid angioplasty (2) and bilateral internal maxillary artery embolization for epistaxis (1). The average procedure duration was 84±33 min, average fluoroscopy time was 26±13 min, average air kerma was 968±622 mGy, average contrast dose was 70±24 mL. Success rate was 98% overall with one case aborted due to non-flow limiting dissection of the carotid artery during access. Conversion from radial to femoral route occurred in 8% of cases because of radial vessel tortousity (2) or insufficient guide catheter support (2). There was one major procedure complication of intraprocedure aneurysm microperforation with coil that did not have clinical consequence and was unrelated to the access route. There were 3 other minor complications (6%) including forearm bruising (1), TIA (1) and thrombus formation on a coil mass (1) that resolved with IA 2b3a inhibitors without sequelae. There were no major bleeding complications. There was one delayed major complication of pulmonary embolus and pneumonia that onset 3 days after discharge that was not related to the access route. All patients were followed up clinically and there were no delayed vessel occlusions or ischemic complications. Two patients (4%) underwent >1 intervention from the same vessel without sequelae. Two patients (4%) were anticoagulated with coumadin at the time of intervention. All cases from the beginning of experience are included in this series. Overall the transradial access route for neurointerventional procedures is manageable in a community hospital setting with reasonable safety. The procedure parameters that are similar to transfemoral cases and have low conversion rate.