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Navigating radial artery loops in neurointerventions
  1. Evan Luther1,
  2. Joshua Burks1,
  3. Isaac Josh Abecassis1,2,
  4. Ahmed Nada1,3,
  5. Rainya Heath1,
  6. Katherine Berry1,
  7. David J McCarthy4,
  8. Vasu Saini1,
  9. Michael Silva1,
  10. Eric Huang1,
  11. Allison Strickland1,5,
  12. Dileep R Yavagal6,
  13. Eric C Peterson1,
  14. Michael R Levitt2,
  15. Robert M Starke1
  1. 1Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  2. 2Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
  3. 3Department of Neurological Surgery, Port Said University, Port Said, Egypt
  4. 4Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  5. 5University of Mississippi Medical Center, Jackson, Mississippi, USA
  6. 6Department of Neurology, University of Miami, Miami, Florida, USA
  1. Correspondence to Dr Evan Luther, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL 33146, USA; evan.luther{at}


Background Although studies continue to demonstrate lower complications in neurointerventions using transradial access (TRA) compared with transfemoral approaches, anatomic radial variants can be difficult to navigate and remain one of the frequent causes of access site conversion.

Objective To evaluate predictors of TRA failure in neuroendovascular patients with radial loops and suggest a protocol for managing these anomalies.

Methods A prospective collection of patients undergoing TRA at participating institutions from July 2018 to September 2020 was reviewed. Patients with a radial loop were identified. Patient demographics and procedural characteristics were evaluated to determine predictors of both TRA failure and successful reduction of the radial loop.

Results We identified 32 transradial neurointerventions in which patients had radial loops. Twenty-two (68.8%) were identified by diagnostic angiography, and the majority were performed for evaluation or treatment of an aneurysm (56.3%). TRA failure occurred in 13 (40.6%) of the cohort and happened more frequently in patients over 60 years of age (p=0.01) and those with recurrent radial artery diameters ≤2 mm (p=0.02). Of the 19 patients who had successful TRA, 12 (63.2%) procedures were performed through the recurrent radial artery.

Conclusion Although radial loops are associated with high transradial failure rates, our results suggest that the presence of a loop is not an absolute contraindication to TRA. Therefore, we recommend attempting loop navigation using our protocol. Patient age, vascular tortuosity, and recurrent radial artery size should help dictate when to convert to an alternative access site.

  • angiography
  • aneurysm
  • intervention
  • navigation
  • technique
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  • Twitter @drjoshabecassis, @KatBerryMD, @Starke_neurosurgery

  • Contributors All authors contributed substantially to this manuscript.

  • Funding RMS: 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. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. He also has an unrestricted research grant from Medtronic and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo, and Cerenovus. EL: research is supported by the SNIS Foundation Fellow/Young Investigator Research Grant. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the SNIS foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval University of Miami Institutional Review Board approval was obtained for this research (20170149).

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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