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Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study
  1. Anna Luisa Kühn,
  2. Katyucia de Macedo Rodrigues,
  3. Jasmeet Singh,
  4. Francesco Massari,
  5. Ajit S Puri
  1. Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Dr Ajit S Puri, Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; Ajit.Puri{at}


Purpose To report the first use of distal radial artery (dRA) access for a variety of neurointerventions and to demonstrate the safety and feasibility of this approach.

Methods A retrospective review of our prospective neurointerventional database of endovascular interventions was conducted and, between May and October 2019, all patients in whom the intervention was performed via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data were collected.

Results 48 patients with a mean age of 64.4 years (range 35–84 years) were included. 27 patients were female. dRA access was achieved in all cases. Conversion to femoral access was required in five cases (10.4%) due to tortuous vessel anatomy and limited support of the catheters in the aortic arch. Interventions performed included aneurysm treatment (with flow diverters, Woven EndoBridge device placement, coiling or stent-assisted coiling), arteriovenous malformation and dural arteriovenous fistula embolization, carotid artery stentings, stroke thrombectomy, thrombolysis for central retinal artery occlusion, intracranial stenting, middle meningeal artery embolization, vasospasm treatment, and spinal angiography with embolization. Radial artery vasospasm was seen in two cases and successfully treated with antispasmolytic medication. No symptomatic radial artery occlusion or ischemic event was observed.

Conclusion dRA access is safe and effective for a variety of neurointerventions. Our preliminary experience with this approach is very promising and shows high patient satisfaction.

  • aneurysm
  • flow diverter
  • angiography
  • intervention

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  • Contributors Study design: ALK, ASP. Data acquisition: all authors. Literature research: ALK, KdMR, FM. Data analysis and interpretation: ALK, ASP. Manuscript preparation: ALK, KdMR, ASP. Revision of manuscript for important intellectual content: FM, JS. Approval of final version of manuscript: all authors.

  • 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 ASP is a consultant for Stryker, Cerenovus, CereVasc, Merit and Medtronic; received a research grant from Stryker Neurovascular and Medtronic; and has stocks in InNeuroCo.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.