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Implementation of a radial long sheath protocol for radial artery spasm reduces access site conversions in neurointerventions
  1. Evan Luther1,
  2. Stephanie H Chen1,
  3. David J McCarthy2,
  4. Ahmed Nada1,
  5. Rainya Heath1,
  6. Katherine Berry1,
  7. Allison Strickland1,
  8. Joshua Burks1,
  9. Michael Silva1,
  10. Samir Sur1,
  11. Dileep R Yavagal3,
  12. Robert M Starke1,
  13. Eric C Peterson1
  1. 1Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  2. 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  3. 3Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
  1. Correspondence to Dr Evan Luther, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL 33127, USA; evan.luther{at}


Background Many neurointerventionalists have transitioned to transradial access (TRA) as the preferred approach for neurointerventions as studies continue to demonstrate fewer access site complications than transfemoral access. However, radial artery spasm (RAS) remains one of the most commonly cited reasons for access site conversions. We discuss the benefits, techniques, and indications for using the long radial sheath in RAS and present our experience after implementing a protocol for routine use.

Methods A retrospective review of all patients undergoing neurointerventions via TRA at our institution from July 2018 to April 2020 was performed. In November 2019, we implemented a long radial sheath protocol to address RAS. Patient demographics, RAS rates, radial artery diameter, and access site conversions were compared before and after the introduction of the protocol.

Results 747 diagnostic cerebral angiograms and neurointerventional procedures in which TRA was attempted as the primary access site were identified; 247 were performed after the introduction of the long radial sheath protocol. No significant differences in age, gender, procedure type, sheath sizes, and radial artery diameter were seen between the two cohorts. Radial anomalies and small radial diameters were more frequently seen in patients with RAS. Patients with clinically significant RAS more often required access site conversion (p<0.0001), and in our multivariable model use of the long sheath was the only covariate protective against radial failure (OR 0.061, 95% CI 0.007 to 0.517; p=0.0103).

Conclusion In our experience, we have found that the use of long radial sheaths significantly reduces the need for access site conversions in patients with RAS during cerebral angiography and neurointerventions.

  • angiography
  • technique
  • intervention
  • artery
  • device
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  • Contributors All authors contributed significantly to this manuscript.

  • Funding RMS's research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and by National Institute of Health (R01NS111119-01A1) and (UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. He also has an unrestricted research grant from Medtronic and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo and Cerenovus. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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

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