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New Devices and Techniques
Transradial approach for diagnostic cerebral angiograms in the elderly: a comparative observational study
  1. Ahmad Sweid1,
  2. Somnath Das1,
  3. Joshua H Weinberg1,
  4. Kareem E l Naamani2,
  5. Julie Kim3,
  6. Darcy Curtis3,
  7. Daniel Joffe3,
  8. Cannon Greco Hiranaka3,
  9. Darshana Vijaywargiya4,
  10. Chrissa Sioka5,
  11. Mazen Oneissi6,
  12. Abdel Hadi El Hajjar7,
  13. Michael Reid Gooch1,
  14. Nabeel Herial1,
  15. Stavropoula I Tjoumakaris1,
  16. Robert H Rosenwasser1,
  17. Pascal Jabbour1
  1. 1 Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  2. 2 School of Medicine, Lebanese American University, Beirut, Lebanon
  3. 3 Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
  4. 4 Government Medical College, Mysore, Karnataka, India
  5. 5 University of Ioannina, Ioannina, Epirus, Greece
  6. 6 Baylor College of Medicine, Houston, Texas, USA
  7. 7 Saint Joseph University, Beirut, Lebanon
  1. Correspondence to Dr Pascal Jabbour, Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA; pascal.jabbour{at}jefferson.edu

Abstract

Background The transradial approach (TRA) reduces mortality, morbidity, access site complications, hospital cost, and length of stay while maximizing patient satisfaction. We aimed to assess the technical success and safety of TRA for elderly patients (aged ≥75 years).

Methods A retrospective chart review and comparative analysis was performed for elderly patients undergoing a diagnostic cerebral angiogram performed via TRA versus transfemoral approach (TFA). Also, a second comparative analysis was performed among the TRA cohort between elderly patients and their younger counterparts.

Results Comparative analysis in the elderly (TRA vs TFA) showed no significant differences for contrast dose per vessel (43.7 vs 34.6 mL, P=0.106), fluoroscopy time per vessel (5.7 vs 5.2 min, P=0.849), procedure duration (59.8 vs 65.2 min, P=0.057), conversion rate (5.8% vs 2.9%, P=0.650), and access site complications (2.3% vs 2.9%, P=1.00). Radiation exposure per vessel (18.9 vs 51.9 Gy cm2, P=0.001) was significantly lower in the elderly TRA group.

The second comparison (TRA in elderly vs TRA in the young) showed no significant differences for contrast dose per vessel (43.7 vs 37.8 mL, P=0.185), radiation exposure per vessel (18.9 vs 16.5 Gy cm2, P=0.507), procedure duration (59.8 vs 58.3 min, P=0.788), access site complication (2.3% vs 1.7%, P=0.55), and conversation rate (5.8% vs 1.8%, P=0.092). A trend for prolonged fluoroscopy time per vessel (5.7 vs 4.7 min, P=0.050) was observed in the elderly TRA group.

Conclusions TRA is a technically feasible and safe option for diagnostic neurointerventional procedures in the elderly. Our small elderly cohort was not powered enough to show a significant difference in terms of access site complications between TRA and TFA.

  • angiography
  • brain
  • intervention

https://doi.org/10.1136/neurintsurg-2020-016140

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    Footnotes

    • Twitter @AhmadSweidMD, @ReidGooch, @PascalJabbourMD

    • Contributors Conception or design of the work: AS, SD, NH, SIT, JHW, PJ. Data acquisition and analysis: AS, SD, JK, DC, DJ, CGH, KEN. Interpretation of data: AS, SD, CS, PJ. Drafting the work: AS, SD, DV, AHEH. Revising the work for valuable intellectual content: AS, NH, MO, MRG, SIT, PJ, RHR. Approval of the final version: PJ.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests PJ is a consultant for Medtronic and MicroVention. SIT and MRG are consultants for Stryker.

    • Patient consent for publication Not required.

    • Ethics approval All procedures performed in the studies involving human participants were in accordance with the ethical standards of the Institutional Review Board (IRB) or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by the Thomas Jefferson University Institutional Review Board (12D:534). Following the authors' institutional guidelines, all protected health information was removed and individual patient consents were not required for the analysis of this case series.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.