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Neuroimaging
Case series
Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography
  1. Marie-Christine Brunet1,
  2. Stephanie H Chen1,
  3. Samir Sur2,
  4. David J McCarthy3,
  5. Brian Snelling2,
  6. Dileep R Yavagal4,
  7. Robert M Starke1,5,
  8. Eric C Peterson2
  1. 1 Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  2. 2 Neurological Surgery, University of Miami MILLER School of Medicine, Miami, Florida, USA
  3. 3 Neurosurgery, University of Miami School of Medicine, Miami, Florida, USA
  4. 4 Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
  5. 5 University of Miami School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Eric C Peterson, Neurological Surgery, University of Miami Miller School of Medicine, Miami FL 33136, USA; ericpete{at}med.miami.edu

Abstract

Background The transradial approach for endovascular angiography and interventional procedures is superior to the traditional transfemoral approach in several metrics, including lower access-site complication rates, higher patient satisfaction, and lower hospital costs. Interventional cardiologists have begun to adopt the distal transradial approach (dTRA) for coronary interventions as it has an improved safety profile and improved procedural ergonomics. Adaptation of dTRA for neuroendovascular procedures promises similar benefit, but requires a learning curve.

Objective To report the first use of dTRA for diagnostic cerebral angiography and demonstrate the feasibility and safety of a dTRA.

Methods A retrospective review of our prospective institutional database of consecutive cases of cerebral DSA performed via dTRA between August 2018 and December 2018 was performed. Patient demographics, procedural and radiographic metrics, and clinical data were recorded.

Results 85 patients were identified with an average age of 53.8 years (range 18–82); 67 (78.8%) patients were female. 78 patients underwent successful dTRA diagnostic cerebral angiography, with a mean of five vessels catheterized and average fluoroscopy time of 12.0 min, or 2.6 min for each vessel. Seven patients required conversion to transfemoral access, with the most common reason being inability to advance the wire and radial artery spasm. There were no complications.

Conclusion dTRA is associated with decreased rates of radial artery occlusion, ischemic hand events, as well as improved patient comfort, faster periprocedural management, and cost benefits. Our preliminary experience with dTRA for diagnostic cerebral angiography demonstrates excellent feasibility and safety in combination with relative efficiency.

  • angiography
  • aneurysm
  • arteriovenous malformation
  • artery

https://doi.org/10.1136/neurintsurg-2019-014718

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    Footnotes

    • Contributors M-CB, SHC, RMS, ECP: substantial contributions to the conception or design of the work and the acquisition, analysis, and interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SS: substantial contributions to the conception or design of the work and drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DJMcC: substantial contributions to the conception or design of the work and analysis, interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BS, DRY: substantial contributions to the conception or design of the work and interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. We would like to thank Mr. Roberto Suazo for his graphic design expertise in producing our manuscript figures.

    • 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 DRY: Medtronic Neurovascular: consultant; Cerenovus: consultant; Rapid Medical and Neuralanalytics: consultant. RMS: Medtronic Neurovascular: consultant; Penumbra: consultant; Cerenovus: consultant; Abbott: consultant. ECP: Stryker Neurovascular: consultant; Penumbra: consultant; RIST Neurovascular: stockholder; Medtronic Neurovascular: consultant; Cerenovus: consultant. BS: RIST Neurovascular: stockholder.

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

    • Patient consent for publication Not required.