Transradial Approach for Complex Anterior and Posterior Circulation Interventions: Technical Nuances and Feasibility of Using Current Devices

Brian M. Snelling, Samir Sur, Sumedh S. Shah, Justin Caplan, Priyank Khandelwal, Dileep R. Yavagal, Robert M. Starke, Eric C. Peterson

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Despite several studies analyzing the safety of transradial access (TRA) for neurointervention compared to transfemoral approach (TFA), neurointerventionalists are apprehensive about implementing TRA. From our positive institutional experience, we now utilize TRA first line for a majority of our cases. Here, we present our single-institution experience. OBJECTIVE: To determine safety and feasibility of TRA for neurointervention. METHODS: Through retrospective review of patients receiving TRA for anterior and posterior circulation cerebrovascular interventions at our institution between December 2015 and January 2018, we present our experience regarding this transition, while focusing on technique, complications, feasibility, indications, and limitations. RESULTS: One hundred five procedures were performed on 92 patients (anterior circulation: 77%; posterior circulation: 23%). Radial artery access was achieved in all patients. Twenty-nine cases constituted mechanical thrombectomy, 33 cases represented intracranial aneurysms treatments, and 33 cases included interventions like angioplasty, balloon test occlusion, chemotherapy delivery, and thrombolysis. TRA was used as second-line access to TFA in 5 instances due to aortic arch anomalies and atherosclerotic disease. Minor access-site complications were seen in 2.85% of patients. Ten procedures (9.0%) could not be completed with TRA, with crossover to TFA occurring in 7 cases. CONCLUSION: TRA is safe and feasible for the majority of neurointerventional procedures and provides decreased risk of major access-site complications compared to TFA. Perceived limitations of TRA can likely be eliminated via operator experience and engineering ingenuity; thus, there is a role for TRA for neurointervention, especially in patients with increased risk of access-site complications from TFA.

Original languageEnglish (US)
Pages (from-to)293-302
Number of pages10
JournalOperative Neurosurgery
Volume17
Issue number3
DOIs
StatePublished - Sep 1 2019

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Equipment and Supplies
Cerebrovascular Circulation
Safety
Balloon Occlusion
Thrombectomy
Radial Artery
Intracranial Aneurysm
Thoracic Aorta
Angioplasty
Drug Therapy
Therapeutics

Keywords

  • Aneurysm
  • Endovascular
  • Interventions
  • Thrombectomy
  • Transradial access

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Transradial Approach for Complex Anterior and Posterior Circulation Interventions : Technical Nuances and Feasibility of Using Current Devices. / Snelling, Brian M.; Sur, Samir; Shah, Sumedh S.; Caplan, Justin; Khandelwal, Priyank; Yavagal, Dileep R.; Starke, Robert M.; Peterson, Eric C.

In: Operative Neurosurgery, Vol. 17, No. 3, 01.09.2019, p. 293-302.

Research output: Contribution to journalArticle

Snelling, Brian M. ; Sur, Samir ; Shah, Sumedh S. ; Caplan, Justin ; Khandelwal, Priyank ; Yavagal, Dileep R. ; Starke, Robert M. ; Peterson, Eric C. / Transradial Approach for Complex Anterior and Posterior Circulation Interventions : Technical Nuances and Feasibility of Using Current Devices. In: Operative Neurosurgery. 2019 ; Vol. 17, No. 3. pp. 293-302.
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abstract = "BACKGROUND: Despite several studies analyzing the safety of transradial access (TRA) for neurointervention compared to transfemoral approach (TFA), neurointerventionalists are apprehensive about implementing TRA. From our positive institutional experience, we now utilize TRA first line for a majority of our cases. Here, we present our single-institution experience. OBJECTIVE: To determine safety and feasibility of TRA for neurointervention. METHODS: Through retrospective review of patients receiving TRA for anterior and posterior circulation cerebrovascular interventions at our institution between December 2015 and January 2018, we present our experience regarding this transition, while focusing on technique, complications, feasibility, indications, and limitations. RESULTS: One hundred five procedures were performed on 92 patients (anterior circulation: 77{\%}; posterior circulation: 23{\%}). Radial artery access was achieved in all patients. Twenty-nine cases constituted mechanical thrombectomy, 33 cases represented intracranial aneurysms treatments, and 33 cases included interventions like angioplasty, balloon test occlusion, chemotherapy delivery, and thrombolysis. TRA was used as second-line access to TFA in 5 instances due to aortic arch anomalies and atherosclerotic disease. Minor access-site complications were seen in 2.85{\%} of patients. Ten procedures (9.0{\%}) could not be completed with TRA, with crossover to TFA occurring in 7 cases. CONCLUSION: TRA is safe and feasible for the majority of neurointerventional procedures and provides decreased risk of major access-site complications compared to TFA. Perceived limitations of TRA can likely be eliminated via operator experience and engineering ingenuity; thus, there is a role for TRA for neurointervention, especially in patients with increased risk of access-site complications from TFA.",
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T2 - Technical Nuances and Feasibility of Using Current Devices

AU - Snelling, Brian M.

AU - Sur, Samir

AU - Shah, Sumedh S.

AU - Caplan, Justin

AU - Khandelwal, Priyank

AU - Yavagal, Dileep R.

AU - Starke, Robert M.

AU - Peterson, Eric C.

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N2 - BACKGROUND: Despite several studies analyzing the safety of transradial access (TRA) for neurointervention compared to transfemoral approach (TFA), neurointerventionalists are apprehensive about implementing TRA. From our positive institutional experience, we now utilize TRA first line for a majority of our cases. Here, we present our single-institution experience. OBJECTIVE: To determine safety and feasibility of TRA for neurointervention. METHODS: Through retrospective review of patients receiving TRA for anterior and posterior circulation cerebrovascular interventions at our institution between December 2015 and January 2018, we present our experience regarding this transition, while focusing on technique, complications, feasibility, indications, and limitations. RESULTS: One hundred five procedures were performed on 92 patients (anterior circulation: 77%; posterior circulation: 23%). Radial artery access was achieved in all patients. Twenty-nine cases constituted mechanical thrombectomy, 33 cases represented intracranial aneurysms treatments, and 33 cases included interventions like angioplasty, balloon test occlusion, chemotherapy delivery, and thrombolysis. TRA was used as second-line access to TFA in 5 instances due to aortic arch anomalies and atherosclerotic disease. Minor access-site complications were seen in 2.85% of patients. Ten procedures (9.0%) could not be completed with TRA, with crossover to TFA occurring in 7 cases. CONCLUSION: TRA is safe and feasible for the majority of neurointerventional procedures and provides decreased risk of major access-site complications compared to TFA. Perceived limitations of TRA can likely be eliminated via operator experience and engineering ingenuity; thus, there is a role for TRA for neurointervention, especially in patients with increased risk of access-site complications from TFA.

AB - BACKGROUND: Despite several studies analyzing the safety of transradial access (TRA) for neurointervention compared to transfemoral approach (TFA), neurointerventionalists are apprehensive about implementing TRA. From our positive institutional experience, we now utilize TRA first line for a majority of our cases. Here, we present our single-institution experience. OBJECTIVE: To determine safety and feasibility of TRA for neurointervention. METHODS: Through retrospective review of patients receiving TRA for anterior and posterior circulation cerebrovascular interventions at our institution between December 2015 and January 2018, we present our experience regarding this transition, while focusing on technique, complications, feasibility, indications, and limitations. RESULTS: One hundred five procedures were performed on 92 patients (anterior circulation: 77%; posterior circulation: 23%). Radial artery access was achieved in all patients. Twenty-nine cases constituted mechanical thrombectomy, 33 cases represented intracranial aneurysms treatments, and 33 cases included interventions like angioplasty, balloon test occlusion, chemotherapy delivery, and thrombolysis. TRA was used as second-line access to TFA in 5 instances due to aortic arch anomalies and atherosclerotic disease. Minor access-site complications were seen in 2.85% of patients. Ten procedures (9.0%) could not be completed with TRA, with crossover to TFA occurring in 7 cases. CONCLUSION: TRA is safe and feasible for the majority of neurointerventional procedures and provides decreased risk of major access-site complications compared to TFA. Perceived limitations of TRA can likely be eliminated via operator experience and engineering ingenuity; thus, there is a role for TRA for neurointervention, especially in patients with increased risk of access-site complications from TFA.

KW - Aneurysm

KW - Endovascular

KW - Interventions

KW - Thrombectomy

KW - Transradial access

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