1
|
Catapano JS, Winkler EA, Srinivasan VM, Dishion EL, Rutledge C, Baranoski JF, Cole TS, Rudy RF, Rumalla K, Zomaya MP, Jadhav AP, Ducruet AF, Albuquerque FC. Retained radial catheters associated with variant radial anatomy in neurointerventional procedures. J Neurointerv Surg 2023; 15:858-863. [PMID: 36190952 DOI: 10.1136/jnis-2022-019004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
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.
Collapse
Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Ethan A Winkler
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Evan L Dishion
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Robert F Rudy
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Martin P Zomaya
- The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| |
Collapse
|
2
|
Fuga M, Tanaka T, Tachi R, Tomoto K, Kazami K, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Risk factors for radial artery occlusion after neurointervention for unruptured intracranial aneurysm via transradial access. Interv Neuroradiol 2023:15910199231189927. [PMID: 37499188 DOI: 10.1177/15910199231189927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Neurointervention via transradial access (TRA) is less invasive than via transfemoral access. However, radial artery occlusion (RAO) may occur with TRA. The purpose of this study was to explore risk factors for RAO after coil embolization of unruptured intracranial aneurysms (UIAs) via TRA. METHODS Forty-two consecutive patients who underwent coil embolization for UIAs via TRA between March 2021 and March 2022 and were available for angiographic evaluation 1 year after treatment were retrospectively reviewed. Multivariate logistic regression analysis was conducted to identify potential risk factors for RAO. RESULTS Seventeen (40%) of the 42 patients showed RAO. Compared with the non-RAO group, radial artery size was significantly smaller (2.2 mm [interquartile range (IQR): 2.1, 2.4 mm] vs 2.6 mm [IQR: 2.5, 2.7 mm]; p = 0.001) and the incidence of radial artery spasm (RAS) was significantly higher in the RAO group. Multivariate analysis identified radial artery size (odds ratio [OR] 4.9 × 10-3, 95% confidence interval [CI] 6.4 × 10-5-0.38) and incidence of RAS (OR 14.8, 95%CI 2.1-105) as significant independent predictors of subsequent RAO. Based on receiver operating characteristic (ROC) curve analysis, the optimal cutoff for radial artery size was 2.5 mm (sensitivity, 82.4%; specificity, 76.0%; area under the ROC curve, 0.80 [95%CI 0.66-0.95]). CONCLUSION Radial artery size and RAS represent reliable parameters for predicting RAO 1 year after coil embolization for UIA via TRA. Prophylaxis against RAS and limiting neurointervention via TRA to patients with radial artery larger than 2.5 mm in diameter may reduce the risk of postoperative RAO.
Collapse
Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Kyoichi Tomoto
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Kenta Kazami
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Mini N, Zartner PA, Sabir H, Suchowerskyj P, Schneider MB. Echocardiogram-Guided Stenting of a Critical Aortic Coarctation in an Extremely Low Weight Preterm Infant. JACC Case Rep 2023; 13:101815. [PMID: 37077754 PMCID: PMC10107088 DOI: 10.1016/j.jaccas.2023.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 04/21/2023]
Abstract
We report a case of critical aortic coarctation in an extremely low birth weight preterm infant weighing 600 g that was successfully treated with interventional stent implantation. The intervention was guided by echocardiography without using contrast agent due to associated renal failure. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Nathalie Mini
- Department of Cardiology, German Pediatric Heart Centre, University Hospital of Bonn, Bonn, Germany
- Address for correspondence: Dr Nathalie Mini, Cardiac Catheterization Laboratory, Pediatric Heart Centre, University Hospital of Bonn, Campus Venusberg 1, 53721 Bonn, Germany.
| | - Peter A. Zartner
- Department of Cardiology, German Pediatric Heart Centre, University Hospital of Bonn, Bonn, Germany
| | - Hemmen Sabir
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Philipp Suchowerskyj
- Department of Cardiology, German Pediatric Heart Centre, University Hospital of Bonn, Bonn, Germany
| | - Martin B.E. Schneider
- Department of Cardiology, German Pediatric Heart Centre, University Hospital of Bonn, Bonn, Germany
| |
Collapse
|
4
|
Meng S, Guo Q, Tong G, Shen Y, Tong X, Gu J, Li X. Development and Validation of a Nomogram for Predicting Radial Artery Spasm During Coronary Angiography. Angiology 2023; 74:242-251. [PMID: 35574924 DOI: 10.1177/00033197221098278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study describes an attempt to develop a user-friendly nomogram incorporating psychological factors to individually predict the risk of radial artery spasm. Patients consecutively recruited between June 2020 and June 2021 constituted the development cohort for retrospective analysis of the development of a prediction model. Least absolute shrinkage and selection operator regression combined with clinical significance was employed to screen out appropriate independent variables. The model's discrimination and calibration were subsequently evaluated and calibrated by using the C-index, receiver operating characteristic (ROC) curve, and calibration plot. Decision curve analysis was also performed to evaluate the net benefit with the nomogram, and internal validation was assessed using bootstrapping validation. The predictors included in the risk nomogram included "body mass index ," "anxiety score," "duration of interventional surgery," "latency time (time spent waiting in the catheterization laboratory)," "vascular circuity (substantial changes in the curvature of vessels)," and "puncture number." The derived model showed good discrimination with an area under the ROC curve of .77, a C-index of .771 (95% CI: .72-.822) and good calibration. Decision curve analysis indicated that the nomogram provided a better net benefit than the alternatives.
Collapse
Affiliation(s)
- Shasha Meng
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qixin Guo
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Cardiology, 74734The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guoxin Tong
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Shen
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoshan Tong
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junjie Gu
- Department of Cardiology, 74630Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinli Li
- Department of Cardiology, 74734The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
5
|
Narsinh KH, Mirza MH, Caton MT, Baker A, Winkler E, Higashida RT, Halbach VV, Amans MR, Cooke DL, Hetts SW, Abla AA, Dowd CF. Radial artery access for neuroendovascular procedures: safety review and complications. J Neurointerv Surg 2021; 13:1132-1138. [PMID: 34551991 DOI: 10.1136/neurintsurg-2021-017325] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/16/2021] [Indexed: 01/01/2023]
Abstract
Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we reviewed anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. In this second part of the review series, we aim to (1) summarize evidence for safety of the transradial approach, and (2) explain complications and their management.
Collapse
Affiliation(s)
- Kazim H Narsinh
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Mohammed H Mirza
- Radiology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - M Travis Caton
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Amanda Baker
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Ethan Winkler
- Neurological Surgery, University California San Francisco, San Francisco, California, USA
| | - Randall T Higashida
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Van V Halbach
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Matthew R Amans
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Daniel L Cooke
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Steven W Hetts
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Adib A Abla
- Neurological Surgery, University California San Francisco, San Francisco, California, USA
| | - Christopher F Dowd
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| |
Collapse
|
6
|
Arterial innervation, vasodilatation, and the resolution of ultrasound. Anaesth Crit Care Pain Med 2021; 40:100914. [PMID: 34171537 DOI: 10.1016/j.accpm.2021.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
|
7
|
Sinha C, Kumar A, Kumari P, Kumar A, Bhar D, Singh V. Does radial or median nerve blocks affect the area and blood flow of radial artery? Anaesth Crit Care Pain Med 2021; 40:100831. [PMID: 33744492 DOI: 10.1016/j.accpm.2021.100831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Radial artery is a common site of cannulation in acute care setting. There are conflicting reports as to which nerve, radial or median or both supplies the radial artery. We did this prospective study in patients undergoing minor procedures under peripheral nerve blocks to ascertain which nerve block, radial or median increases the cross sectional area and blood flow in the radial artery. METHODS Ninety ASA I/II patients undergoing upper limb minor surgeries under various blocks (radial or median or radial + median nerve) were enrolled in this study. Patients in group R were those who received Ultrasound-guided (USG) radial nerve block, group M median nerve block while group MR received both the nerve blocks. The primary objective was to assess the increase in cross sectional area (CSA) of radial artery in the groups after the block. Secondary objectives included assessment of time average maximum velocity (TAMAX) and blood volume (BV) after the block. RESULTS The CSA, TAMAX and BV of radial artery increased in all the three groups. Within each group the difference between the preblock and postblock parameters were highly significant. However, the differences are greater in groups M and M + R than in group R; (P < 0.001). CONCLUSION Ultrasound-guided median nerve block causes arterial vasodilation, and an increase in radial artery blood flow velocity. There was no added benefit of radial block along with median block in increasing the blood flow further.
Collapse
Affiliation(s)
- Chandni Sinha
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Amarjeet Kumar
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Patna, India.
| | - Poonam Kumari
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Ajeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Ditipriya Bhar
- Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Veena Singh
- Department of Burn & Plastic Surgery, All India Institute of Medical Sciences (AIIMS), Patna, India
| |
Collapse
|
8
|
Abstract
Transradial access (TRA) is favored over transfemoral access for performing coronary angiography and percutaneous coronary intervention due to the reduced risk for vascular and bleeding complications and the documented survival benefit in ST-segment–elevation myocardial infarction patients who undergo primary percutaneous coronary intervention. TRA complications can be categorized as intra- or postprocedural and further categorized as related to bleeding or nonbleeding issues. Major intra- and postprocedural complications such as radial artery perforation and compartment syndrome are rare following TRA. Their occurrence, however, can be associated with morbid consequences, including requirement for surgical intervention if not identified and treated promptly. Nonbleeding complications such as radial artery spasm and radial artery occlusion are typically less morbid but occur much more frequently. Strategies to prevent TRA complications are essential and include the use of contemporary access techniques that limit arterial injury. This document summarizes contemporary techniques to prevent, identify, and manage TRA complications.
Collapse
Affiliation(s)
- Yader Sandoval
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Malcolm R. Bell
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| |
Collapse
|
9
|
Amitani K, Tanioka S, Ishiyama M, Nishimura K. Treatment of Transradial Angiogram Catheter Entrapment by Axillary Artery Spasm With Supraclavicular Brachial Plexus Block. A A Pract 2018; 11:131-133. [DOI: 10.1213/xaa.0000000000000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Radial artery spasm treatment by radial, median, or musculocutaneous nerve block? A potential therapeutic dilemma. Can J Anaesth 2018; 65:590. [DOI: 10.1007/s12630-018-1054-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 01/22/2023] Open
|
11
|
Bhakta P, Zaheer H. In reply: Radial artery spasm treatment by radial, median, or musculocutaneous nerve block? A potential therapeutic dilemma. Can J Anaesth 2018; 65:591. [DOI: 10.1007/s12630-018-1055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022] Open
|
12
|
|
13
|
Reply to Dr Grocott. Reg Anesth Pain Med 2018; 43:221-222. [PMID: 29356779 DOI: 10.1097/aap.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Backman SB. Radial artery spasm: Should we worry? Can J Anaesth 2017; 64:1165-1168. [PMID: 28822090 DOI: 10.1007/s12630-017-0946-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Steven B Backman
- Department of Anesthesia, McGill University, Royal Victoria Hospital, Glen Site, Montreal, QC, Canada.
| |
Collapse
|
15
|
Kabukcu HK, Bostanci A, Turhan M, Titiz TA. In reply: Using a Mcintosh blade for retromolar intubation: a comment. Can J Anaesth 2017; 64:1157-1158. [PMID: 28815489 DOI: 10.1007/s12630-017-0944-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/07/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Hanife Karakaya Kabukcu
- Department of Anesthesiology and Reanimation, Akdeniz University Medical Faculty, Antalya, Turkey.
| | - Asli Bostanci
- Department of Ear Nose and Throat, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Murat Turhan
- Department of Ear Nose and Throat, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Tulin Aydogdu Titiz
- Department of Anesthesiology and Reanimation, Akdeniz University Medical Faculty, Antalya, Turkey
| |
Collapse
|