1
|
Kular S, Maiter A, Martin A, Dyde R, Waterworth A, Radatz MWR, Cahill J, Tse GH. Trans-radial cerebral angiography for stereotactic radiosurgery treatment of arteriovenous malformations. Clin Radiol 2024; 79:e941-e948. [PMID: 38710602 DOI: 10.1016/j.crad.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 03/21/2024] [Accepted: 04/06/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES The popularity of trans-radial access (TRA) for cerebral angiography is growing. Potential benefits of TRA over traditional trans-femoral access (TFA) are multitude. This study aimed to evaluate discharge outcomes and patient opinion of TRA compared to TFA in patients undergoing cerebral angiography prior to stereotactic radiosurgery (SRS) treatment for cerebral arteriovenous malformations. METHODS Consecutive patients treated at the National Centre for Stereotactic Radiosurgery (Sheffield, United Kingdom) over a 22-month period were included. All patients underwent cerebral angiography with either TRA or TFA as part of treatment planning prior to SRS. TRA patients who had previously undergone TFA in other centres were surveyed for their experience of cerebral angiography using a questionnaire. SRS staff at our centre was approached for their opinion. RESULTS 492 patients were included (median age = 43 years, 57.5% male, median lesions treated = 1). More patients underwent angiography with TFA (75.2%) than TRA (24.8%). No difference was found in accumulated dose for angiography between the groups (p>0.05). There was 17.6% reduction in overnight stay between TRA and TRF, the proportion of patients requiring overnight admission was higher for the TFA (35.2%) than TRA (17.6%, p<0.05). 101 patients were surveyed, with a response rate of 47%. Most respondents (79%) indicated preference for TRA over TFA. CONCLUSIONS Use of TRA in pre-SRS cerebral angiography is feasible and improves both patient and staff experience. The adoption of TRA could have important implications for department resources and costs by reducing the proportion of overnight admissions.
Collapse
Affiliation(s)
- S Kular
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - A Maiter
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK
| | - A Martin
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - R Dyde
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - A Waterworth
- Scientific Computing, Department of Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - M W R Radatz
- National Centre for Stereotactic Radiosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - J Cahill
- National Centre for Stereotactic Radiosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - G H Tse
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK.
| |
Collapse
|
2
|
Rentiya ZS, Kuhn AL, Hutnik R, Shazeeb MS, De Leacy RA, Goldman D, Singh J, Puri AS. Transradial access for cerebral angiography and neurointerventional procedures: A meta-analysis and systematic review. Interv Neuroradiol 2024; 30:404-411. [PMID: 35837726 DOI: 10.1177/15910199221112200] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Transradial access (TRA) for diagnostic and interventional neurointerventional procedures has recently gained traction over transfemoral access (TFA) in the neurointerventional community. This meta-analysis aims to assess and summarize the utility of TRA in cerebral angiography and neurointerventional procedures. METHODS A systematic literature review was performed utilizing Pubmed, Embase, and Scopus databases. Using PRISMA guidelines, records were extracted with the following search terms: transradial approach, transradial access, radial access, cerebral angiogram, cerebral angiography, neurointervention, and neuroendovascular. The primary outcomes assessed were case success rate, complication rate, and crossover rate from TRA to TFA. Secondary analysis was performed on procedure time, fluoroscopy time, fluoroscopy time per vessel (diagnostic procedures only), contrast dose, radial artery diameter, distal radial artery diameter, and patient preference for TRA over TFA. RESULTS Sixty-two full-text articles were analyzed for this meta-analysis, representing 12,927 diagnostic and interventional TRA access patients. Our analysis revealed a combined diagnostic and interventional case success rate of 95.9% and complication rate of 3.5%, with crossover to TFA occurring in 4.9% of cases. CONCLUSION This meta-analysis demonstrates that TRA access for diagnostic angiography and neurointerventional procedures is a safe and effective approach, though determining a true complication rate is challenging as the definition of TRA complications has changed in various publications over time.
Collapse
Affiliation(s)
- Zubir S Rentiya
- Image Processing & Analysis Core (iPAC), Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Anna Luisa Kuhn
- Image Processing & Analysis Core (iPAC), Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Robert Hutnik
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Mohammed Salman Shazeeb
- Image Processing & Analysis Core (iPAC), Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Reade A De Leacy
- Department of Neurosurgery & Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daryl Goldman
- Department of Neurosurgery & Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jasmeet Singh
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| |
Collapse
|
3
|
Hu B, Li J, Li L, Yin H, Zheng C, Fan L. Neuro-Interventional Diagnosis and Treatment Using the Right Transradial Approach in Patients with Aberrant Right Subclavian Artery. World Neurosurg 2024; 185:e1330-e1337. [PMID: 38521216 DOI: 10.1016/j.wneu.2024.03.083] [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: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To assess the effectiveness and safety of neurological interventions using the right transradial approach (R-TRA) in patients with aberrant right subclavian artery (ARSA). METHODS We retrospectively analyzed cases that underwent cerebral angiography and interventions at Huangpi District People's Hospital from January 2023 to July 2023. Out of 335 cases, 5 patients with ARSA were identified. RESULTS All 5 cases underwent diagnostic cerebral angiography via R-TRA. Two of the patients received interventions via R-TRA: 1 underwent right internal carotid artery balloon dilation angioplasty, while another underwent left vertebral artery stenting. No surgery-related complications were observed during these procedures. CONCLUSIONS R-TRA proves to be a safe and effective option for neuro-interventional surgery in patients with ARSA.
Collapse
Affiliation(s)
- Bin Hu
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Jing Li
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China.
| | - Liang Li
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Hao Yin
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Chong Zheng
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Liu Fan
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| |
Collapse
|
4
|
Umekawa M, Koizumi S, Ohara K, Ishigami D, Miyawaki S, Saito N. Distal radial artery approach is safe and effective for cerebral angiography and neuroendovascular treatment: A single-center experience with ultrasonographic measurement. Interv Neuroradiol 2024; 30:280-287. [PMID: 36285518 PMCID: PMC11095355 DOI: 10.1177/15910199221135308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/10/2022] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The transradial artery approach to cerebral angiography can reduce both patient stress following examination and the risk of major complications due to hematoma. Recently, the distal radial artery approach (DRA) has garnered attention in cardiology as a minimally invasive method. DRA is also considered applicable to neurosurgery, although concerns about procedural difficulty and complications persist. Therefore, this study aimed to evaluate the efficacy of the DRA in cerebral angiography and neuroendovascular treatment. METHODS We retrospectively selected 30 consecutive patients for whom the DRA was attempted for cerebral angiography at our hospital. The patients' age, sex, height, weight, and medical history information was collected and correlated with successful puncture and complications. The diameter of the distal radial artery (RA) was measured using ultrasonography. RESULTS The median patient age was 67 years (range, 32-87 years) and 21 (70%) were men. The median diameter of the distal RA was 2.3 mm (range, 1.7-3.2 mm). Distal RA puncture was successful in 23 patients (77%) and no complications were noted; however there was no significant correlation between successful puncture and any of the patient factors. Carotid artery stenting and preoperative tumor embolization were performed via DRA in six and three cases, respectively. Although puncture site hematoma occurred in only one case, all treatments were successful, and no major complications were observed. CONCLUSION DRA can be safely used for cerebral angiography and neuroendovascular treatment.
Collapse
Affiliation(s)
- Motoyuki Umekawa
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kenta Ohara
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Daiichiro Ishigami
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| |
Collapse
|
5
|
Hanaoka Y, Abe D, Koyama JI, Nakamura T, Kitamura S, Horiuchi T. A new very-small-bore Simmons guiding sheath for transradial neurointervention: Technical note and initial experience. J Neuroradiol 2024; 51:214-219. [PMID: 37625629 DOI: 10.1016/j.neurad.2023.08.004] [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: 06/08/2023] [Revised: 07/22/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
Transradial access during neurointerventions has increased in popularity because of reduced complications and patient preference. Nevertheless, transradial cannulation into the left common carotid artery can be difficult technically because of the lack of catheter support in the aortic arch. Furthermore, the use of large sheaths can increase the risk of complications at the access site. Here, we developed a new very-small-bore transradial system using a 3F Simmons guiding sheath, to increase the procedural success rate and minimize access-site complications. This system can represent a valuable treatment option for neurointerventions and has the potential to expand the indications for transradial access.
Collapse
Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan.
| | - Daishiro Abe
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Satoshi Kitamura
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| |
Collapse
|
6
|
Iancu A, Tudor R, Chita DS, Juratu C, Tudor A, Buleu F, Popa D, Brad S. Mechanical Thrombectomy via Transbrachial Approach in the Emergency Management of Acute Ischemic Stroke Patients with Aortic Pathologies: Our Experience and Literature Review. J Pers Med 2024; 14:216. [PMID: 38392649 PMCID: PMC10890389 DOI: 10.3390/jpm14020216] [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: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
STUDY DESIGN Mechanical thrombectomy (MT) via the transbrachial approach (TBA) is a very rare option used in cases of patients with aortic pathologies and acute ischemic stroke (AIS) due to the insufficient evidence in the literature, the difficulty from a technical point of view and the result of this technique influenced by the complications that frequently accompany it. BACKGROUND Only a few cases of patients with aortic pathologies and acute ischemic stroke where MT via TBA were reported in the literature, and its application in the emergency management of AIS has still not been dealt with in detail. OBJECTIVES Out of a need to clarify and clearly emphasize the effectiveness of this approach in emergency MT via TBA in patients with AIS and aortic pathologies, this literature review and case report has the following objectives: the first one is the presentation of an emergency MT via transbrachial approach performed in a 44-year-old patient with AIS and diagnosed aortic coarctation during transfemural approach (TFA), with successful reperfusion in our department and the second one is to review the cases reports of patients with different aortic pathologies and AIS reperfusion therapy performed by MT via TBA from the literature. METHODS A total of nine cases (one personal case and eight published cases) were revised in terms of aortic pathologies type, reperfusion therapy type, and the complication of both mechanical thrombectomy and local transbrachial approach. RESULTS Mechanical thrombectomy through the transbrachial approach was the first choice in more than half of these cases (55.55%, n = 5 cases) in the treatment of acute ischemic stroke in the presence of previously diagnosed aortic pathologies. In one-third of all cases (33.33%, n = 3, our case and 2 case reports from the literature), the transbrachial approach was chosen after attempting to advance the guiding catheter through the transfemoral approach and intraprocedural diagnosis of aortic pathology. In only one case, after an ultrasound evaluation of the radial artery that showed a monophasic flow, MT was performed via TBA. Local transbrachial complication was reported in one case, and in two other cases, it was not stated if there were such complications. Hemorrhagic transformation of AIS was reported in two cases that underwent MT-only cerebral reperfusion via TBA, one with acute aortic dissection type A and our case of previously undiagnosed aortic coarctation. In the cases in whom short and long-term follow-up was reported, the outcome of treatment, which was not exclusively endovascular (77.77% cases with only MT and 33.33% with association of first thrombolysis and after MT), was good (six from nine patients). In two case reports, the outcomes were not stated, and one patient died after a long hospitalization in the intensive care unit from respiratory complications (our patient). CONCLUSIONS Being a clinical emergency, acute ischemic stroke requires urgent medical intervention. In patients with aortic pathologies, where acute ischemic stroke emergency care is a challenge, mechanical thrombectomy via the transbrachial approach is a safe alternative method for cerebral reperfusion.
Collapse
Affiliation(s)
- Aida Iancu
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
| | - Raluca Tudor
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
- Department of Neurology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania
| | - Dana Simona Chita
- Department of Neurology, Faculty of General Medicine, "Vasile Goldis" Western University of Arad, 310025 Arad, Romania
| | - Catalin Juratu
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
| | - Anca Tudor
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania
| | - Florina Buleu
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
- Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania
| | - Daian Popa
- Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania
- Department of Surgery, Emergency Discipline, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Silviu Brad
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania
| |
Collapse
|
7
|
Kojima A, Hosoi M, Hayashi K, Fukumura M, Saga I. Middle Meningeal Artery Embolization for Refractory Chronic Subdural Hematoma Associated with Acute Myeloid Leukemia: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2024; 18:47-52. [PMID: 38384392 PMCID: PMC10878736 DOI: 10.5797/jnet.cr.2023-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Objective We describe a patient with leukemia-related chronic subdural hematoma (CSDH) who was successfully treated using the combination of surgical evacuation and middle meningeal artery (MMA) embolization. Case Presentation A 73-year-old man without apparent head trauma history was admitted to our hospital because of acute myeloid leukemia (AML). Head CT on admission revealed mild CSDH on both sides. Medical treatment options, including chemotherapy, were started. Since a decrease in platelet count and disseminated intravascular coagulation were observed on day 4, recombinant thrombomodulin was administered. As the patient exhibited signs of altered consciousness due to the enlargement of the right CSDH on day 10, we performed surgical drainage. Despite subsequent platelet transfusion and administration of goreisan, the right CSDH recurred within a short period. On day 17, we performed the second surgery and MMA embolization in one stage. The postoperative clinical course was favorable without recurrence of the hematoma. The patient eventually died on day 123 from a deterioration of his general condition. Conclusion Although MMA embolization has recently been recognized as an effective treatment option for recurrent CSDH, there are no published reports addressing the efficacy of MMA embolization for refractory CSDH associated with hematological malignancies. Findings from the management of this case suggest that MMA embolization can be the effective treatment option for CSDH in patients with severe hemorrhagic diathesis due to AML.
Collapse
Affiliation(s)
- Atsuhiro Kojima
- Department of Neurosurgery, Saitama City Hospital, Saitama, Saitama, Japan
| | - Masataka Hosoi
- Department of Internal Medicine, Saitama City Hospital, Saitama, Saitama, Japan
| | - Kanako Hayashi
- Department of Internal Medicine, Saitama City Hospital, Saitama, Saitama, Japan
| | - Mariko Fukumura
- Department of Neurosurgery, Saitama City Hospital, Saitama, Saitama, Japan
| | - Isako Saga
- Department of Neurosurgery, Saitama City Hospital, Saitama, Saitama, Japan
| |
Collapse
|
8
|
Gao Y, Liu B, Yang H, Wang G, Huang J, Li C, Zhao P, Yang L, Yang Z. Comparison of Transradial Access and Transfemoral Access for Diagnostic Cerebral Angiography in the Elderly Population. World Neurosurg 2024; 181:e411-e421. [PMID: 37858864 DOI: 10.1016/j.wneu.2023.10.071] [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: 09/26/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Evaluate the efficacy, safety, and patient satisfaction of transradial access (TRA) compared with conventional transfemoral access (TFA) for diagnostic cerebral angiography in elderly patients (≥65 years of age). METHODS We performed a retrospective review of patients receiving cerebral angiography via TRA or TFA between October 2020 and December 2021 at 3 institutions. Basic patient characteristics, angiographic data, postoperative complications, and patient satisfaction were collected for analysis. RESULTS Of the 357 enrolled elderly patients, 175 were performed through TRA and 182 were performed through TFA. There was no significant difference in mean fluoroscopy time (8.6 ± 3.8 minutes vs. 9.1 ± 3.1 minutes; P = 0.103) and radiation exposure (47.7 ± 10.8 Gy-cm2 vs. 49.8 ± 11.3 Gy-cm2; P = 0.068) between the TRA and TFA groups. However, the TRA group had a shorter procedural time (54.7 ± 6.2 minutes vs. 61.1 ± 5.6 minutes; P < 0.001) and less contrast agent (83.2 ± 28.1 mL vs. 100.1 ± 26.2 mL; P < 0.001) than the TFA group. In terms of safety, the incidence of minor vascular access complications in the TRA group was lower than that in the TFA group (1.7% vs. 8.8%; P = 0.003). The incidence of serious complications and neurologic complications in the TRA group was also lower, although the difference was not statistically significant. Overall patient satisfaction was higher in the TRA group than that in the TFA group. CONCLUSIONS TRA was an efficient and safe alternative to conventional TFA in elderly patients who underwent diagnostic cerebral angiography and who underwent TRA were more satisfied. Findings supported the radial-first strategy for cerebral angiography in elderly populations.
Collapse
Affiliation(s)
- Yang Gao
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Bin Liu
- Department of Neurology, Minhang Central Hospital, Shanghai, China; Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hantao Yang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Guiping Wang
- Department of Neurology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jinlong Huang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Puyuan Zhao
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Liangliang Yang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhigang Yang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China; Department of Neurosurgery, National Clinical Research Center for Interventional Medicine of China, Shanghai, China.
| |
Collapse
|
9
|
Tanoue S, Ono K, Toyooka T, Nakagawa M, Wada K. Feasibility and Challenges of Transradial Approach in Neuroendovascular Therapy: A Retrospective Observational Study. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 18:10-17. [PMID: 38260040 PMCID: PMC10800168 DOI: 10.5797/jnet.oa.2023-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/12/2023] [Indexed: 01/24/2024]
Abstract
Objective Transradial approach (TRA) is increasingly used as a viable alternative to the traditional transfemoral approach (TFA) in neuroendovascular therapy (NET) owing to its potential anatomical benefits and lower puncture-site complication rates. However, the real-world challenges of implementing TRA-NET have not been thoroughly studied, particularly those related to guide catheter (GC) placement. In this study, we aimed to explore the feasibility and challenges of TRA-NET, with a specific focus on GC placement. Methods This retrospective observational study included patients who underwent NET at our institution between December 2019 and May 2022. Procedural success was defined as the successful placement of a GC in the target vessel. Cases in which a Simmons-shaped GC was used or the approach was changed to TFA were classified as difficult. Safety was assessed based on the rate of severe puncture-site complications requiring either blood transfusion or surgical intervention. Results Among the 310 patients who underwent NET during the study period, 222 (71.6%) with a median age of 74 years were selected for TRA-NET. The target vessel was in the left anterior circulation (LtAC) in 101 (45.5%) patients, and 8-F GCs were the most frequently used (40.1%). TRA-NET achieved a 95.0% success rate, with a switch to TFA required in 5.0% of the cases. Procedural challenges occurred in 42 (18.9%) patients, primarily in those with LtAC lesions. Specifically, a type III aortic arch (p <0.0001) and age ≥80 years (p = 0.01) were significantly associated with procedural difficulties. Radial artery evaluation was confirmed in 66 cases (29.7%), revealing one instance (1.5%) of radial artery occlusion. No severe puncture-site complications were observed. Conclusion TRA-NET may provide substantial therapeutic benefits without significant limitations in device use. However, it may be challenging, particularly in older patients and those with a type III aortic arch with LtAC lesions. Consequently, careful selection of the approach route is imperative.
Collapse
Affiliation(s)
- Shunsuke Tanoue
- Department of Neurosurgery, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
- Department of Neurosurgery, Mishuku Hospital, Tokyo, Japan
| | - Kenichiro Ono
- Department of Neurosurgery, Mishuku Hospital, Tokyo, Japan
| | - Terushige Toyooka
- Department of Neurosurgery, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Masaya Nakagawa
- Department of Neurosurgery, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| |
Collapse
|
10
|
Wang Y, Zhou Y, Cui G, Xiong H, Wang DL. Transradial versus transfemoral access for posterior circulation endovascular intervention: A systematic review and meta-analysis. Clin Neurol Neurosurg 2023; 234:108006. [PMID: 37864946 DOI: 10.1016/j.clineuro.2023.108006] [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: 06/11/2023] [Revised: 07/21/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Transradial access (TRA) provides a more direct entry to posterior circulation system for endovascular therapy compared to transfemoral access (TFA). This meta-analysis aims to evaluate the safety and feasibility of TRA in neurointervention of posterior circulation. MATERIALS AND METHODS A systematic search was conducted in the Wanfang Data, CBM, PubMed, Embase, Cochrane Library, Web of Science databases. The primary outcomes included total complications and access site complications. Secondary outcomes were single puncture success, procedural success, access cross-over, catheter retention time and fluoroscopy time. RESULTS Six studies encompassing 297 patients were included in the meta-analysis. Compared to the TFA group, the TRA group showed significantly decreased total complications (odds ratio [OR] = 0.29, 95% confidence interval [CI] [0.12, 0.73], p < 0.01) and access site complications (OR = 0.19, 95%CI [0.06, 0.62], p < 0.01), yet it had a longer catheter retention time (mean difference [MD] = 0.80, 95%CI [0.60, 1.00], p < 0.01). There were no significant differences in single puncture success (OR = 3.68, 95%CI[0.38, 35.86], p = 0.26), procedural success (OR = 0.30,95%CI [0.05, 1.73], p = 0.18), access cross-over (OR = 2.29, 95%CI [0.19, 28.26], p = 0.52), fluoroscopy time (MD = 0.97, 95%CI [- 0.91, 2.84], p = 0.31) between the TRA and TFA groups. CONCLUSION This meta-analysis demonstrated that TRA is a safe and feasible alternative to TFA for neurointervention in the posterior circulation. TRA showed significantly decreased total complications and access site complications, yet it had a longer catheter retention time than TFA.
Collapse
Affiliation(s)
- Ying Wang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250000, China
| | - Yi Zhou
- Department of Neurosurgery, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China
| | - Gang Cui
- Department of Neurosurgery, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China
| | - Hui Xiong
- Department of Neurosurgery, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China
| | - De-Liang Wang
- Department of Neurosurgery, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China.
| |
Collapse
|
11
|
Morden FTC, Caballero CG, Abella M, Conching A, Gang H, Noh T. Middle meningeal artery embolization for symptomatic chronic subdural hematoma in the setting of severe transfusion-refractory thrombocytopenia: A case study and review of literature. Surg Neurol Int 2023; 14:223. [PMID: 37404508 PMCID: PMC10316227 DOI: 10.25259/sni_1051_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/03/2023] [Indexed: 07/06/2023] Open
Abstract
Background Surgical decompression for the treatment of chronic subdural hematomas (cSDHs) is irrefutably effective; however, its utility in managing cSDH in patients with comorbid coagulopathy remains controversial. The optimal threshold for platelet transfusion in cSDH management is <100,000/mm3, according to guidelines from the American Association of Blood Banks GRADE framework. This threshold may be unachievable in refractory thrombocytopenia, though surgical intervention may still be warranted. We present a patient with symptomatic cSDH and transfusion-refractory thrombocytopenia successfully treated with middle meningeal artery embolization (eMMA). We also review the literature to identify management approaches for cSDH with severe thrombocytopenia. Case Description A 74-year-old male with acute myeloid leukemia presented to the emergency department with persistent headache and emesis following fall without head trauma. Computed tomography (CT) revealed a 12 mm right-sided, mixed density SDH. Platelets were <2000/mm3 initially, which stabilized to 20,000 following platelet transfusions. He then underwent right eMMA without surgical evacuation. He received intermittent platelet transfusions with platelet goal >20,000 and was discharged on hospital day 24 with resolving SDH on CT. Conclusion High-risk surgical patients with refractory thrombocytopenia and symptomatic cSDH may be successfully treated with eMMA without surgical evacuation. A platelet goal of 20,000/mm3 before and following surgical intervention proved beneficial for our patient. Similarly, a literature review of seven cases of cSDH with comorbid thrombocytopenia revealed five patients undergoing surgical evacuation following initial medical management. Three cases reported a platelet goal of 20,000. All seven cases resulted in stable or resolving SDH with platelets >20,000 at discharge.
Collapse
Affiliation(s)
- Frances Tiffany Cava Morden
- Corresponding author: Frances Tiffany Cava Morden, Division of Neurological Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States.
| | | | | | | | | | | |
Collapse
|
12
|
Muszynski P, Richard S, Finitsis S, Humbertjean L, Audibert G, Mione G, Harsan O, Derelle AL, Liao L, Zhu F, Olivot JM, Anxionnat R, Calvet D, Gory B. Transradial access with Simmons guiding catheter for carotid artery stenting: Feasibility and procedural complications in a single-center experience. Interv Neuroradiol 2023:15910199231171845. [PMID: 37113013 DOI: 10.1177/15910199231171845] [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: 04/29/2023] Open
Abstract
BACKGROUND There is an increasing number of transradial approach (TRA) for carotid artery stenting (CAS), however, similar techniques and materials as for femoral access are used. We report the results of TRA lower profile technique for CAS using a 7 F Simmons guiding catheter, especially in terms of feasibility and procedural safety in a single center. MATERIALS AND METHODS We retrospectively analyzed 68 consecutive patients with symptomatic extracranial carotid stenoses who underwent 75 CAS between January 2018 and December 2021. The success and crossover rate, procedural time, fluoroscopy, clinical outcomes, technical considerations, and procedural complications were analyzed. RESULTS TRA CAS with Simmons guiding catheter was successful in 67/75 (89.3%) cases, with a 7 (9.3%) crossover rate. Fluoroscopy mean time was 15.8 minutes. Two forearm hematomas were described. No ischemic or surgical site complications were reported. CONCLUSIONS In our experience frontline TRA with a 7 F Simmons guiding catheter is feasible with high procedural success and a low rate of access site complications.
Collapse
Affiliation(s)
- P Muszynski
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
| | - S Richard
- Université de Lorraine, Nancy, France
- Department of Neurology, Stroke Unit, CHRU Nancy, France
| | - S Finitsis
- Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - L Humbertjean
- Department of Neurology, Stroke Unit, CHRU Nancy, France
| | - G Audibert
- Department of intensive care unit, CHRU Nancy, France
| | - G Mione
- Department of Neurology, Stroke Unit, CHRU Nancy, France
| | - O Harsan
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
| | - A L Derelle
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
| | - L Liao
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
- Université de Lorraine, Nancy, France
| | - F Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
- Université de Lorraine, Nancy, France
| | - J M Olivot
- Department of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, France
| | - R Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
- Université de Lorraine, Nancy, France
| | - D Calvet
- Neurology and neurovascular unit, GHU Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
- Université de Lorraine, Nancy, France
| |
Collapse
|