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Original research
Feasibility of repeat transradial access for neuroendovascular procedures
  1. Stephanie H Chen1,
  2. Marie-Christine Brunet1,
  3. Samir Sur1,
  4. Dileep R Yavagal2,
  5. Robert M Starke1,
  6. Eric C Peterson1
  1. 1Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  2. 2Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
  1. Correspondence to Dr Stephanie H Chen, Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA; chen.stephanie.h{at}gmail.com

Abstract

Introduction Transradial artery access (TRA) for cerebrovascular angiography is increasing due to decreased access site complications and overwhelming patient preference. While interventional cardiologists have reported up to 10 successive TRA procedures via the same radial access site, this is the first study examining successive use of the same artery for repeat procedures in neurointerventional procedures.1

Methods We reviewed our prospective institutional database for all patients who underwent a transradial neurointerventional procedure between 2015 and 2019. Index procedures were defined as procedures performed via TRA after which there was a second TRA procedure attempted. Reasons for conversion to a transfemoral approach (TFA) for subsequent procedures were identified.

Results 104 patients underwent 237 procedures (230 TRA, 7 TFA). 97 patients underwent ≥2 TRA procedures, 20 patients >3, four patients >4, three patients >5, and two patients >6 TRA procedures. The success rate was 94.7% (126/133) with 52% (66/126) of successive procedures performed via the same radial access site (snuffbox vs antebrachial) while the alternate radial artery segment was used for access in 48% (60/126) of subsequent procedures. There were seven (5.3%) cases requiring crossover to TFA, six cases for radial artery occlusion (RAO) and one for radial artery narrowing.

Conclusion Successive TRA is both technically feasible and safe for neuroendovascular procedures in up to six procedures. The low failure rate (5.3%) was primarily due to RAO. Thus, even without clinical consequences, strategies to minimize RAO should be optimized for patients to continue to benefit from TRA in future procedures.

  • transradial approach
  • radial access
  • angiography
  • endovascular
  • repeat
  • radial artery occlusion
  • neurovascular
  • neurointervention
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Footnotes

  • Twitter @Starke_neurosurgery

  • Contributors All authors contributed to the conception, data gathering, and drafting of the manuscript. DRY, RMS, and ECP provided manuscript oversight and administrative support. All authors critically reviewed the manuscript and approved its final submission.

  • 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.

  • Patient consent for publication Not required.

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

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