Objective To describe feasibility, technique and safety of distal radial access in anatomic snuff box for cerebral angiography. Also, to describe potential advantages and limitations compared to conventional radial access at the wrist and transfemoral access.
Methods We performed retrospective review of cerebral angiography procedures performed or attempted with distal radial access between October 2018 through February 2019, at University Hospital (Newark, NJ). Ultrasound measurement of radial artery in anatomic snuff box was performed in all potential candidates and different approach was performed in patients with <2 mm radial artery diameter. We did not perform Barbeau test, given as cardiology literature suggesting poor prediction for hand ischemia with this test. All access were performed under ultrasound guidance, using single wall technique. After successful access, rest of cerebral angiogram procedure was similar to conventional radial approach. Demographic information, indication, technical details, complications and patient perceptions were collected.
Results Total of 25 cerebral angiography procedures were successfully performed in patients with age ranging 33–78 years, with distal radial access. Once successful access was achieved, intended vessels were catheterized in all patients. One patient had left distal radial access, rest had on Right. On an overage 3.6 (1–6) vessels were catheterized. No major complications were noted. Average procedure end to discharge time was 3 hours and 15 minutes. 2 patient reported prolonged pain at wrist, lasting 1 week. Patients who had prior angiogram with different approach, reported preference for Distal Radial approach. On the other hand, there were 4 failed attempted in the same time period. 2 were converted to conventional radial and 2 transfemoral. These failed attempts were related to severe vasospasm and were in the early part of the learning curve.
Conclusion This single center experience suggests feasibility and safety of distal radial access for cerebral angiography. Most patients in this study who had angiogram by other approach, preferred distal radial approach. In addition, post procedure recovery time is significantly shorter. There should be further large-scale studies to evaluate this potentially useful and in select cases advantageous approach.
Disclosures P. Patel: None. I. Bach: None. N. Majmundar: None. P. Khandelwal: None.
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