Background Transradial artery access (TRA) for neurointerventional procedures is gaining widespread acceptance. However, complications that were previously rare may arise as TRA procedures increase. Here we report a series of retained catheter cases with a literature review.
Methods All patients who underwent a neurointerventional procedure during a 23-month period at a single institution were retrospectively reviewed for a retained catheter in TRA cases. In cases of retained catheters, imaging was reviewed for anatomical variances in the radial artery, and clinical and demographic case details were analyzed.
Results A total of 1386 nondiagnostic neurointerventional procedures were performed during the study period, 631 (46%) initially via TRA. The 631 TRA cases were performed for aneurysm embolization (n=221, 35%), mechanical thrombectomy (n=116, 18%), carotid stent/angioplasty (n=40, 6%), arteriovenous malformation embolization (n=38, 6%), and other reasons (n=216, 34%). Thirty-nine (6%) TRA procedures crossed over to femoral access, most commonly because the artery of interest could not be catheterized (26/39, 67%). A retained catheter was identified in five cases (1%), and one (0.2%) patient had an entrapped catheter that was recovered. All six patients with a retained or entrapped catheter had aberrant radial anatomy.
Conclusion Retained catheters for neurointerventional procedures performed via TRA are rare. However, this complication may be associated with variant radial anatomy. With the increased use of TRA for neurointerventional procedures, awareness of anatomical abnormalities that may lead to a retained catheter is necessary. We propose a simple protocol to avoid catheter entrapment, including in emergent situations such as TRA for stroke thrombectomy.
Data availability statement
Data sharing not applicable as no datasets generated and/or analyzed for this study.
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Correction notice Since this paper first published, the dosage 300 mm Hg has been changed to 30 mm Hg in figure 2. The discussion section of the text has also been updated to reflect this change.
Contributors JSC: drafted the work, conception and design of the work, and critically reviewed. EAW and VMS: drafted the work and critically reviewed. ELD, CR, and JFB: data acquisition, analysis, or interpretation of data for the work. TSC, MPZ, APJ, and AFD: critically reviewed. RFR and KR: drafted the work. FCA: guarantor, accepts full responsibility for the work and conduct of the study, had access to the data, controlled the decision to publish, critically reviewed content, gave final approval of the version to be published, and agrees 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. FCA is the guarantor.
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 FCA and AFD serve on the editorial board of the Journal of NeuroInterventional Surgery.
Provenance and peer review Not commissioned; externally peer reviewed.
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