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Macdonald IR, Pickett GE, Herman C, Lee M, Volders D. All that glitters: case presentation and review of radial access complications in neurointervention. Interv Neuroradiol 2023; 29:327-331. [PMID: 35234068 PMCID: PMC10369111 DOI: 10.1177/15910199221083787] [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: 12/12/2021] [Accepted: 01/31/2022] [Indexed: 11/15/2022] Open
Abstract
Radial artery access has experienced increasing adoption and rapid expansion of indications for neurointerventional procedures. This access is an attractive neurointervention route to be considered, with many advantages over the traditional femoral access in terms of ease of vasculature navigation and decreased risk of complications such as significant bleeding. Although a promising technique for neurointerventional procedures, there are inherent and unique considerations as well as potential complications involved. The following case report highlights some of these vital concepts associated with radial artery access, including appropriate patient selection as well as assessment of arterial size in the context of neurointerventional techniques. Early identification of complications such as arterial injury and compartment syndrome, with an emphasis on appropriate draping and inter-procedure monitoring, is discussed as well as approaches for subsequent management. Finally, the issue of radiation safety in this emerging technique is considered. These concepts are critical for the successful use and the continued growth of radial artery access for neurointervention procedures.
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Affiliation(s)
- Ian R Macdonald
- Division of Neuroradiology, Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gwynedd E Pickett
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Herman
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Min Lee
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Volders
- Division of Neuroradiology, Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Kühn AL, Satti SR, Eden T, de Macedo Rodrigues K, Singh J, Massari F, Gounis MJ, Puri AS. Anatomic Snuffbox (Distal Radial Artery) and Radial Artery Access for Treatment of Intracranial Aneurysms with FDA-Approved Flow Diverters. AJNR Am J Neuroradiol 2021; 42:487-492. [PMID: 33446501 DOI: 10.3174/ajnr.a6953] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/08/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Transradial access for neurointerventional procedures has been proved a safer and more comfortable alternative to femoral artery access. We present our experience with transradial (distal radial/anatomic snuffbox and radial artery) access for treatment of intracranial aneurysms using all 3 FDA-approved flow diverters. MATERIALS AND METHODS This was a high-volume, dual-center, retrospective analysis of each institution's data base between June 2018 and June 2020 and a collection of all patients treated with flow diversion via transradial access. Patient demographic information and procedural and radiographic data were obtained. RESULTS Seventy-four patients were identified (64 female patients) with a mean age of 57.5 years with a total of 86 aneurysms. Most aneurysms were located in the anterior circulation (93%) and within the intracranial ICA (67.4%). The mean aneurysm size was 5.5 mm. Flow diverters placed included the Pipeline Embolization Device (Flex) (PED, n = 65), the Surpass Streamline Flow Diverter (n = 8), and the Flow-Redirection Endoluminal Device (FRED, n = 1). Transradial access was successful in all cases, but femoral crossover was required in 3 cases (4.1%) due to tortuous anatomy and inadequate support of the catheters in 2 cases and an inability to navigate to the target vessel in a patient with an aberrant right subclavian artery. All 71 other interventions were successfully performed via the transradial approach (95.9%). No access site complications were encountered. Asymptomatic radial artery occlusion was encountered in 1 case (3.7%). CONCLUSIONS Flow diverters can be successfully placed via the transradial approach with high technical success, low access site complications, and a low femoral crossover rate.
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Affiliation(s)
- A L Kühn
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - S R Satti
- Department of Neurointerventional Surgery (S.R.S., T.E.), Christiana Health System, Newark, Delaware
| | - T Eden
- Department of Neurointerventional Surgery (S.R.S., T.E.), Christiana Health System, Newark, Delaware
| | - K de Macedo Rodrigues
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - J Singh
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - F Massari
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - M J Gounis
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - A S Puri
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
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Li Y, Chen SH, Spiotta AM, Jabbour P, Levitt MR, Kan P, Griessenauer CJ, Arthur AS, Osbun JW, Park MS, Chalouhi N, Sweid A, Wolfe SQ, Fargen KM, Dumont AS, Dumont TM, Brunet MC, Sur S, Luther E, Strickland A, Yavagal DR, Peterson EC, Schirmer CM, Goren O, Dalal S, Weiner G, Rosengart A, Raper D, Chen CJ, Amenta P, Scullen T, Kelly CM, Young C, Nahhas M, Almallouhi E, Gunasekaran A, Pai S, Lanzino G, Brinjikji W, Abbasi M, Dornbos Iii D, Goyal N, Peterson J, El-Ghanem MH, Starke RM. Lower complication rates associated with transradial versus transfemoral flow diverting stent placement. J Neurointerv Surg 2021; 13:91-95. [PMID: 32487766 PMCID: PMC7708402 DOI: 10.1136/neurintsurg-2020-015992] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Currently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion. METHODS We retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches. RESULTS A total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035). CONCLUSION TRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series.
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Affiliation(s)
- Yangchun Li
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephanie H Chen
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael R Levitt
- Neurological Surgery, Radiology and Mechanical Engineering and Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Christoph J Griessenauer
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
- Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
| | - Adam S Arthur
- Department of Neurological Surgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joshua W Osbun
- Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Min S Park
- Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Nohra Chalouhi
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ahmad Sweid
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Travis M Dumont
- Neurosurgery, Neurology and Medical Imaging, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Marie-Christine Brunet
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Samir Sur
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Allison Strickland
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Dileep R Yavagal
- Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
| | - Eric C Peterson
- Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Clemens M Schirmer
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
- Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Oded Goren
- Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Shamsher Dalal
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gregory Weiner
- Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA
| | - Axel Rosengart
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Daniel Raper
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Peter Amenta
- Neurological Surgery, Tulane Medical Center Downtown, New Orleans, Louisiana, USA
| | - Tyler Scullen
- Neurosurggery, Tulane University, New Orleans, Louisiana, USA
| | - Cory Michael Kelly
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Christopher Young
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael Nahhas
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eyad Almallouhi
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Suhas Pai
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - Mehdi Abbasi
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David Dornbos Iii
- Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Nitin Goyal
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jeremy Peterson
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | - Mohammad H El-Ghanem
- Neurosurgery, Neurology and Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
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