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New devices and techniques
Original research
Predicting the degree of difficulty of the trans-radial approach in cerebral angiography
  1. Nickalus R Khan1,2,
  2. Jeremy Peterson1,2,
  3. David Dornbos III1,2,
  4. Vincent Nguyen1,2,
  5. Nitin Goyal3,4,
  6. Radmehr Torabi1,2,
  7. Daniel Hoit1,2,
  8. Lucas Elijovich3,4,
  9. Violiza Inoa-Acosta3,4,
  10. David Morris5,
  11. Christopher Nickele1,2,
  12. Pascal Jabbour6,
  13. Eric C Peterson7,
  14. Adam S Arthur1,2
  1. 1 Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2 Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  3. 3 Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  4. 4 Neurology, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  5. 5 Mid-South Imaging and Therapeutics PA, Memphis, Tennessee, USA
  6. 6 Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  7. 7 Neurological Surgery, University of Miami, Miami, Florida, USA
  1. Correspondence to Dr Adam S Arthur, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN 38120-2300, USA; aarthur{at}semmes-murphey.com

Abstract

Background To evaluate anatomical and clinical factors that make trans-radial cerebral angiography more difficult.

Methods A total of 52 trans-radial diagnostic angiograms were evaluated in a tertiary care stroke center from December 2019 until March 2020. We analyzed a number of anatomical variables to evaluate for correlation to outcome measures of angiography difficulty.

Results The presence of a proximal radial loop had a higher conversion to femoral access (p<0.03). The presence of a large diameter aortic arch (p<0.01), double subclavian innominate curve (p<0.01), left proximal common carotid artery (CCA) loop (p<0.001), acute subclavian vertebral angle (p<0.01), and absence of bovine aortic arch anatomy (p=0.03) were associated with more difficult trans-radial cerebral angiography and increased fluoroscopy time-per-vessel.

Conclusion The presence of a proximal radial loop, large diameter aortic arch, double subclavian innominate curve, proximal left CCA loop, acute subclavian vertebral angle, and absence of bovine aortic arch anatomy were associated with more difficult trans-radial cerebral angiography. We also introduce a novel grading scale for diagnostic trans-radial angiography.

  • catheter
  • CT Angiography
  • guidewire
  • artery

Data availability statement

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

https://doi.org/10.1136/neurintsurg-2020-016448

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    Data availability statement

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

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    Footnotes

    • Twitter @DornbosIII_MD, @vnnguyen, @PascalJabbourMD, @AdamArthurMD

    • Contributors All authors of this work met ICMJE criteria for authorship and made substantial contributions to the conception and design, acquisition of data, analysis and interpretation of data, drafting, critical revising, and final approval of this manuscript.

    • 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 DH serves as a consultant for Covidien/Medtronic and Microvention; and is a shareholder of Cerebrotech, Marblehead Medical, and Silver Bullett. LE serves as a consultant for Balt, Cerenovus, Medtronic, MicroVention, Penumbra, and Stryker. CN has received research support from Microvention. PJ is a consultant for Medtronic and MicroVention. ECP is a consultant for Cerenovus, Medtronic Neurovascular, Penumbra, and Stryker Neurovascular; and is a shareholder of RIST Neurovascular. ASA is a consultant for Johnson and Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, and Stryker; receives research support from Balt, Cerenovus, Medtronic, Microvention, Penumbra, Siemens, and Stryker; and is a shareholder in Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad Medical, and Vascular Simulations.

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