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Sheikh BY, Abd Elziz MS, Almuzaini MK, Alhejaili KA, Alharbi EK, Andijany AM, Alharbi FH, Alahmadi HA. Ultrasonographic Characterizations of Radial Artery for Transradial Approach in the Saudi Population: A Pilot Study. Cureus 2024; 16:e65532. [PMID: 39188479 PMCID: PMC11346669 DOI: 10.7759/cureus.65532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2024] [Indexed: 08/28/2024] Open
Abstract
Background The radial artery originates from the brachial artery at the level of the neck of the radius in the cubital fossa. It has multiple branches all over its course, and it is an important artery for multiple procedures across several fields. Objectives The objective of this article is to assess the size and characteristics of the radial artery in the Saudi population for the transradial approach. It aims to compare the diameters of the distal and proximal radial arteries using ultrasonography and determine the clinical significance of the findings in selecting an appropriate catheter size among different demographic groups. Additionally, the study aims to contrast the obtained results with international standards to provide a comprehensive analysis of the radial artery characteristics in the Saudi population. Methods A pilot study was conducted at a Medina region hospital in Madinah from December 2022 to July 2023. An ultrasonographic assessment of the right radial artery was performed on a sample of 45 volunteers. Results Our results showed a significantly larger mean diameter of the right ulnar artery in males compared to females. No other significant differences were observed in the characteristics of the right proximal radial artery (PRA), distal radial artery (DRA), or ulnar artery between genders. Significant differences in arterial characteristics were observed across different body mass index (BMI) categories for several parameters. Depth measurements in the right PRA displayed notable differences across age groups, and the ulnar artery showed significant variability among age categories. No statistically significant differences were found in arterial characteristics across smoking categories. Conclusion Our study on Saudi Arabian radial artery ultrasonography reveals potential clinical correlations, highlighting the influence of age and BMI on arterial characteristics. Further research is needed to confirm these findings and explore demographic determinants.
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Affiliation(s)
- Bassem Y Sheikh
- Neurosurgery, King Salman bin Abdulaziz Medical City, Madinah, SAU
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. A narrative review of history, advantages, future developments of the distal radial access. J Vasc Access 2024; 25:745-752. [PMID: 36262018 DOI: 10.1177/11297298221129416] [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] [Indexed: 11/17/2022] Open
Abstract
This article presents a historical excursus and a review of modern literature on distal radial access for interventional surgery, discussing the anatomical and physiological substantiation of the use of this access point in endovascular surgery, its advantages and disadvantages. The main considerations directly related to distal puncture, choice of instrumentation, hemostasis, possible complications, and prevention are analyzed. The major areas of interventional surgery (coronary, vascular, oncological, and neurointerventional), where the distal radial approach is actively used, are reflected and their characteristics are highlighted. In general, it has been shown that with the development of technology, improved manual skills, the widespread use of hydrophilic introducers, and modern sheathless guiding catheters, the vessel diameter, and puncture site are not decisive factors when choosing access for any type of intervention.
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Sato D, Umekawa M, Koizumi S, Ishigami D, Kiyofuji S, Saito N. Trans-Distal Radial Artery Carotid Revascularization with Forearm Flow Reversal: An Alternative Option of CAS in the TCAR Era. World Neurosurg 2024; 183:e920-e927. [PMID: 38237802 DOI: 10.1016/j.wneu.2024.01.058] [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: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Transcarotid artery revascularization (TCAR) has emerged as an alternative to carotid artery stenting (CAS). TCAR demonstrated its superiority by avoiding femoral artery puncture and establishing proximal protection without crossing the stenotic lesion. In the TCAR era, we focused on the possibility of a trans-distal radial approach (DRA). A balloon-guide catheter was navigated via DRA to establish proximal protection before lesion crossing. The forearm subcutaneous vein was used as the flow-reversal circuit. METHODS Six internal carotid artery stenosis patients underwent CAS using "the forearm flow reversal technique." Every procedure was performed under continuous flow reversal from the common carotid artery to the forearm cephalic vein. RESULTS Successful revascularization was achieved without ischemic or access-site complications. The distal radial artery was patent at discharge in all cases. CONCLUSIONS Trans-distal radial CAS with forearm flow reversal is a feasible and less invasive technical option.
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Affiliation(s)
- Daisuke Sato
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
| | - Daiichiro Ishigami
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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Nunna R, Tariq F, Jummah F, Bains N, Qureshi AI, Siddiq F. Advances in the Endovascular Management of Cerebrovascular Disease. MISSOURI MEDICINE 2024; 121:127-135. [PMID: 38694595 PMCID: PMC11057869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The field of endovascular neurosurgery has experienced remarkable progress over the last few decades. Endovascular treatments have continued to gain traction as the advancement of technology, technique, and procedural safety has allowed for the expansion of treatment indications of various cerebrovascular pathologies. Interventions such as the coiling of intracranial aneurysms, carotid artery stenting, mechanical thrombectomy in the setting of ischemic stroke, and endovascular embolization of arteriovenous malformations have all seen transformations in their safety and efficacy, expanding the scope of endovascularly treatable conditions and offering new hope to patients who may have otherwise not been candidates for surgical intervention. Despite this notable progress, challenges persist, including complications associated with device deployment and questions regarding long-term outcomes. This article explores the advancements in endovascular neurosurgical techniques, highlighting the impact on patient care, outcomes, and the evolution of traditional surgical methods.
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Affiliation(s)
- Ravi Nunna
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Farzana Tariq
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Fareed Jummah
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Navpreet Bains
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri-Columbia, Columbia, Missouri
| | - Farhan Siddiq
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
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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.
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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
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Orscelik A, Senol YC, Kobeissi H, Ghozy S, Bilgin C, Arul S, Kadirvel R, Brinjikji W, Kallmes DF. Distal versus conventional transradial access for diagnostic cerebral angiography and neurointerventional procedures: A systematic review and meta-analysis. Interv Neuroradiol 2023:15910199231210411. [PMID: 37936400 DOI: 10.1177/15910199231210411] [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: 11/09/2023] Open
Abstract
BACKGROUND Distal transradial artery access (dTRA) has received increasing consideration for performing diagnostic cerebral angiography and neurointerventional procedures. In this meta-analysis, we aim to evaluate the safety and efficacy of dTRA compared to conventional transradial access (cTRA) for cerebral angiography and neurointerventions. METHOD A systematic review and meta-analysis were conducted on studies investigating outcomes of dTRA and cTRA in neurointerventions. The primary outcome was technical success rates. Secondary outcomes included access site complication rates, crossover rates to alternative vessels, fluoroscopy time, and contrast volume. The random effects model was used to calculate the mean difference (MD) and odds ratios (OR) with 95% confidence intervals (Cl). RESULTS Eight retrospective observational studies with a total of 1477 patients who underwent 1175 diagnostic cerebral angiography and 516 neurointerventional procedures using 546 dTRA and 1164 cTRA approaches were included in our meta-analysis. The technical success rate was similar between dTRA and cTRA groups (95.8% vs 91.4%; OR:1.65; 95% Cl: 0.52 to 5.22; P = 0.40). Similarly, no difference was seen in dTRA and cTRA regarding access site complications (2% vs 1.4%; OR: 1.31; 95% CI: 0.47 to 3.61; P = 0.61) and access site crossover (2.1% vs 5.3%; OR: 0.55; 95% Cl: 0.28 to 1.05; P = 0.07). After resolving heterogeneity among included studies, dTRA was associated with a shorter fluoroscopy time (MD: -0.91 min; 95% CI: -1.74 to -0.09; P = 0.03) and lower contrast volume (MD: -8.32 mL; 95% CI = -14.7 to -1.94; P = 0.011). CONCLUSION Our findings suggest that the dTRA approach is a safe and effective alternative to the cTRA approach in patients undergoing cerebral angiography and neurointerventions.
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Affiliation(s)
| | - Yigit Can Senol
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Santhosh Arul
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Inomata Y, Hanaoka Y, Koyama JI, Yamazaki D, Kitamura S, Nakamura T, Horiuchi T. Left Transradial Access Using a Radial-Specific Neurointerventional Guiding Sheath for Coil Embolization of Anterior Circulation Aneurysm Associated With the Aberrant Right Subclavian Artery: Technical Note and Literature Review. World Neurosurg 2023; 178:126-131. [PMID: 37506842 DOI: 10.1016/j.wneu.2023.07.107] [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: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Aberrant right subclavian artery (ARSA) is a rare condition, but the most common anomaly of the aortic arch. Although neurointerventions via transradial access (TRA) are becoming increasingly popular worldwide, transradial carotid cannulation has been extremely challenging in patients with an ARSA. Herein, we present a case of ARSA-associated anterior communicating artery (ACoA) aneurysm that was successfully treated with a radial-specific 6F Simmons guiding sheath via left TRA. We also review the relevant literature. METHODS A 68-year-old-woman who was diagnosed as having an ARSA-associated ACoA aneurysm underwent simple coiling via left TRA. After the 6F Simmons guiding sheath was engaged into the right common carotid artery using the pull-back-technique, transradial quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/coil-delivery microcatheter) was implemented. RESULTS Simple coiling of the aneurysm was successfully achieved without catheter kinking or system instability. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 1 years 9 months after the procedure. CONCLUSIONS Transradial anterior circulation intervention has been rarely used for patients with an ARSA due to unfavorable catheter trajectory. Left TRA using the 6F Simmons guiding sheath is a useful treatment option to address anterior circulation interventions for patients with an ARSA. Preoperative diagnosis of ARSA is necessary for the application of our method.
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Affiliation(s)
- Yuki Inomata
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Kitamura
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
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Dodd WS, Small CN, Goutnik M, Laurent D, Crossman J, Motwani K, Lucke-Wold B, Polifka AJ, Koch M, Brzezicki G, Hoh BL, Chalouhi N. Cost Comparison: Evaluating Transfemoral and Transradial Access for Diagnostic Cerebral Angiography. STROKE (HOBOKEN, N.J.) 2023; 3:e000428. [PMID: 36743257 PMCID: PMC9893797 DOI: 10.1161/svin.122.000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Modern medicine necessitates the delivery of increasingly complex health care while minimizing cost. Transradial access (TRA) for neuroendovascular procedures is becoming more common as accumulating data demonstrate fewer complications, improved patient satisfaction, and high rates of treatment success compared with the transfemoral access (TFA) approach; however, disparities in cost between these approaches remain unclear. We compared supply and equipment costs between TRA and TFA for diagnostic cerebral angiography and evaluate the specific items that account for these differences. METHODS We reviewed all adult patients who underwent diagnostic cerebral angiography from July 1, 2019 to December 31, 2019. Data related to patient demographics, vascular access site, catheters used, cost of catheters, arterial access sheath use, cost of sheaths, closure devices used, and cost of closure devices were collected. RESULTS The transradial approach resulted in higher price of radial access sheath; however, the overall cost of closure devices was much lower in TRA group than in the TFA cohort. There was no significant difference in the cost of catheters. Overall, the total supply costs for TRA cerebral angiography were significantly lower than those of TFA cerebral angiography. The relative materials cost difference of using TRA was 20.9%. CONCLUSION This study is the first itemized materials cost analysis of TRA versus TFA cerebral angiography. TRA necessitates the use of a more expensive access sheath device; however, this cost is offset by the increased cost of devices used for femoral arteriotomy closure. Overall, the supply and equipment costs were significantly lower for TRA than TFA.
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Affiliation(s)
- William S Dodd
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Coulter N Small
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Michael Goutnik
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - James Crossman
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Kartik Motwani
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Matthew Koch
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Grzegorz Brzezicki
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Nohra Chalouhi
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
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Bhatia V, Kumar A, Wani MY, Singla N, Prabhakar A, Karthigeyan M, Chauhan R. Therapeutic Neurointervention through Transradial Approach: Preliminary Experience from a Tertiary Care Center. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1758778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
Aim The aim of this study was to assess the safety and feasibility of radial access for therapeutic neurointervention procedures.
Methods The retrospective evaluation of 20 patients taken for therapeutic neurointervention through transradial access at our institute was done from July 2021 to April 2022.
Results Therapeutic neurointervention procedures were attempted in 20 patients (age, 24–74 years; mean age, 48.4 years; 13 (65%) females using a transradial approach. The radial artery's mean diameter was 2.135 mm. The right radial access was taken in 18 (90%) cases. Indications for treatment were ruptured aneurysm in 13 (65%), mechanical thrombectomy in 5 (25%), flow diversion for a recanalized aneurysm in 1 (5%), and balloon occlusion test in 1 (5%) case. The procedure was successful through the transradial approach in 18 (90%) procedures. Failure was seen in two cases that were completed after conversion to the transfemoral approach. The reason for access conversion was a severe spasm in both cases. No significant access site complications were seen in the study cohort.
Conclusion A radial access route is a promising approach for therapeutic interventions with a high success rate and minimal access site complications. Interventionists should get accustomed to this approach as primary or alternative access for neurointervention.
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Affiliation(s)
- Vikas Bhatia
- Department of Radio-Diagnosis, Section of Neuroimaging and Interventional Neuroradiology, PGIMER Chandigarh, India
| | - Ajay Kumar
- Department of Radio-Diagnosis, Section of Neuroimaging and Interventional Neuroradiology, PGIMER Chandigarh, India
| | - Mohd Yaqoob Wani
- Department of Radio-Diagnosis, Section of Neuroimaging and Interventional Neuroradiology, PGIMER Chandigarh, India
| | | | - Anuj Prabhakar
- Department of Radio-Diagnosis, Section of Neuroimaging and Interventional Neuroradiology, PGIMER Chandigarh, India
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Tarasyuk ES, Annaev ZS. Distal radial artery access in noncoronary procedures. Curr Probl Cardiol 2022:101207. [PMID: 35460683 DOI: 10.1016/j.cpcardiol.2022.101207] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
Since the beginning of interventional cardiology and for decades, the femoral artery has been the access of choice for both diagnostic and interventional endovascular procedures. Due to an extensive evidence base accumulated over the last 20 years, the majority of interventional cardiologists around the world prefer classical radial artery access for both elective and emergency procedures. A similar trend has been observed for distal radial artery access over the last five years. Noncoronary endovascular surgery undergoes the same stages of improvement and optimization of access, but in a more accelerated way. The goal of this review is to analyze the literature on distal radial artery access in noncoronary procedures.
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Affiliation(s)
- A V Korotkikh
- Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russia.
| | | | | | - E S Tarasyuk
- Amur Regional Clinical Hospital, Blagoveshchensk, Russia
| | - Z S Annaev
- Novyy Urengoy Central Hospital, Novyy Urengoy, Russia
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Saal-Zapata G, Rodríguez-Varela R. Initial Experience Using the Transradial Approach for Endovascular Treatment of Vascular Pathologies: Safety and Feasibility. J Neurosci Rural Pract 2022; 13:123-128. [PMID: 35110932 PMCID: PMC8803504 DOI: 10.1055/s-0041-1742136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Endovascular treatment of vascular pathologies through the transradial approach has been increasingly used and has demonstrated a low rate of complications.
Objective
To report our initial experience in the endovascular treatment of cerebrovascular diseases with the transradial approach and to determine its safety and feasibility.
Methods
Consecutive patients who underwent the transradial approach for endovascular treatment of aneurysms and vascular malformations were reviewed at a single institution. Technical success, fluoroscopy time, and access-related complications were analyzed.
Results
Eight patients underwent endovascular treatment with the transradial approach. One arteriovenous fistula, one superficial temporal artery aneurysm, three arteriovenous malformations, and four aneurysms were treated successfully. The radial artery was successfully approached and a 6-F sheath was used in all the cases. Navigation of guiding catheters (5 and 6 F) was done without complications. The most commonly approached artery was the right internal carotid artery, followed by the right vertebral artery. Postoperative vasospasm was identified in three patients. Mean fluoroscopy time was 34.7 minutes. Conversion to transfemoral approach was not required. No postoperative complications were reported.
Conclusions
In our initial experience, the transradial approach is a safe and feasible alternative for the endovascular treatment of cerebrovascular pathologies.
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Affiliation(s)
- Giancarlo Saal-Zapata
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara Irigoyen, La Victoria, Lima, Peru
| | - Rodolfo Rodríguez-Varela
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara Irigoyen, La Victoria, Lima, Peru
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12
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BINDRA S, GHATAS M, RAJHANS A, AHN SS. Radial artery access for peripheral endovascular procedures. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.21.01522-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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.
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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
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Couldwell M, Elzamly K, Hextrum S, Aysenne A, Olewink Ł, Iwanaga J, Nerva J, Dumont AS, Tubbs RS. Wrist Extension Does Not Change the Position of the Radial Artery: Cadaveric Study With Application to Arterial Line Placement, and Transradial Neurointerventional Procedures. World Neurosurg 2021; 155:e588-e591. [PMID: 34474160 DOI: 10.1016/j.wneu.2021.08.105] [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: 07/26/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The radial artery is gaining popularity as a vascular access site for neurointerventional procedures. However, recent analyses of wrist position and radial artery anatomy has suggested that the extended position of the wrist is not always necessary. Therefore, the following cadaveric study was performed to verify these findings. METHODS Twenty adult cadaveric upper limbs underwent dissection of the radial artery. The radial artery was exposed but left in its anatomical position. With the hand supinated, the wrist was extended to 45 degrees and 90 degrees. Observations were then made of any movement of the artery during these ranges of motion. Next, a tension gauge was attached to the radial artery and any tension on the artery measured during the above noted ranges of motion. RESULTS During extension of the wrist, none of the radial artery specimens was found to move in any direction. Moreover, an average of only 0.28 N of tension on the artery was found with wrist extension up to 90 degrees. Our cadaveric study found that, contrary to popular belief, extension of the wrist during cannulation of the radial artery does not change the position of the artery nor does it significantly alter the tension on the artery. CONCLUSIONS These data support several recent clinical studies.
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Affiliation(s)
- Mitchell Couldwell
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Kareem Elzamly
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shannon Hextrum
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aimee Aysenne
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Łukasz Olewink
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - John Nerva
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Surgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies; University of Queensland, Australia
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15
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Manzoor MU, Alrashed AA, Almulhim IA, Althubait S, Al-Qahtani SM, Al-Senani F, Alturki AY. Exploring the path less traveled: Distal radial access for diagnostic and interventional neuroradiology procedures. J Clin Neurosci 2021; 90:279-283. [PMID: 34275564 DOI: 10.1016/j.jocn.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/03/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recently there is a trend for radial first which advocates radial artery access as the first choice to perform diagnostic and interventional neurovascular procedures. Although safer than the conventional common femoral artery access, it is associated with a high rate of radial artery occlusion. Distal radial artery access is recently proposed to avoid this complication. This study aims to assess the feasibility and safety of distal radial artery access across a wide range of interventional neurovascular procedures. MATERIALS AND METHODS All Interventional neurovascular cases attempted via distal radial artery access from September 2019 till March 2021 were included in the study. Data regarding patient demographics, distal radial artery diameter, access site cannulation, size of the sheath, procedural details including success rate and complications were collected. RESULTS During the study period, 102 patients underwent 114 procedures via the distal radial artery approach. The mean age of patients was 41.9 ± 15.2 years. Overall procedure success rate via DRA was 94.7% (108/114). 72 diagnostic cerebral angiograms and 36 interventional procedures were successfully completed while six procedures required switching to alternate access. CONCLUSION Distal radial artery access is a safe and feasible option for diagnostic cerebral angiography and a wide range of neurovascular procedures.
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Affiliation(s)
- Muhammad U Manzoor
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Abdullah A Alrashed
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim A Almulhim
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shorog Althubait
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sultan M Al-Qahtani
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahmi Al-Senani
- Department of Neurology & Stroke Medicine, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Y Alturki
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia; Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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