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Original research
Maturing institutional experience with the transradial approach for diagnostic cerebral arteriography: overcoming the learning curve
  1. Benjamin M Zussman1,
  2. Daniel A Tonetti1,
  3. Jeremy Stone1,
  4. Merritt Brown2,
  5. Shashvat M Desai2,
  6. Bradley A Gross1,
  7. Ashutosh Jadhav2,
  8. Tudor G Jovin3,
  9. Brian Thomas Jankowitz1
  1. 1 Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2 Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3 Neurology, Cooper University, Camden, NJ, USA
  1. Correspondence to Dr. Brian Thomas Jankowitz, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA ; ankbt{at}upmc.edu

Abstract

Background Despite growing interest in the transradial approach for neurovascular procedures, prospective data about the learning curve for neurointerventionalists adopting this approach are limited.

Methods A subsequent prospective series of 50 consecutive right transradial diagnostic cerebral arteriograms was compared with our initial institutional experience using a procedural staging system. The primary outcome was the ability to achieve the predefined procedural goals using the radial approach. Secondary outcomes included the technical ability to access and inject each supraaortic artery of interest and the incidence of complications.

Results The primary outcome was achieved in 49 patients (98%) compared with 88% in the initial series (p=0.05). One stage 2 failure (2%) occurred. Crossover to the transfemoral approach occurred in one patient (2%) compared with 8% in the initial series (p=0.16). All supraaortic arteries of interest were accessed and injected with success rates between 93% and 100%. There were no major complications and two minor complications.

Conclusion Neurointerventionalists can overcome the right transradial learning curve and achieve high success rates and low crossover rates after performing 30–50 cases.

  • transradial
  • radial artery
  • diagnostic cerebral angiography technique
  • learning curve
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Footnotes

  • Contributors Drafting the article: BMZ, DAT. Study conception: BMZ, DAT, BTJ. Data acquisition: BMZ, DAT, JS, MB. Data analysis: SMD, BMZ, DAT, BTJ. Study supervision: AJ, TGJ, BAG, BTJ. Critical revision of manuscript: All authors. Final approval of manuscript: All authors.

  • Funding This work was supported by grant number UN2018-ARMPITT from the Pittsburgh Foundation and by grant entitled ’Arterial Radial Management at UPMC' from Microvention Inc.

  • Competing interests BTJ: Consultant: Medtronic. TGJ: Consultant: Stryker Neurovascular; Ownership Interest: Anaconda; Advisory Board/Investor: FreeOx Biotech; Advisory Board/Investor: Route92; Advisory Board/Investor: Blockade Medical; Consultant; Honoraria: Cerenovus. BAG: Consultant: Microvention.

  • Ethics approval This study was approved by our institutional Quality Improvement Committee.

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

  • Patient consent for publication Not required.

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