Radial Access for Neurointervention

2021 ◽  
Keyword(s):  
Femoral Artery ◽  
Lower Risk ◽  
Vascular Complications ◽  
Artery Occlusion ◽  
Arterial Access ◽  
Transradial Access ◽  
Pseudo Aneurysm ◽  
Neurointerventional Procedures ◽  
Device Technology

Although femoral artery catheterization has been the mainstay of arterial access for cerebral angiography, there has been a recent increase in the use of transradial access among neurointerventionalists. Despite its widespread use among interventional cardiologists, there is a paucity of evidence for its use in the neurosurgical literature. With the constant evolution of device technology and the need of multimodal treatments for complex neurovascular pathologies, most neurointerventionalists resort to femoral artery access because of the vessel’s larger diameter and having been trained with that approach. However, transradial access confers a number of benefits, most notably lower risk of vascular complications, shorter recovery, and increased patient satisfaction and cost reduction. Femoral artery catheterization requires patients to tolerate a painful and uncomfortable procedure, with associated potential complications such as pseudo-aneurysm formation, retroperitoneal hematoma, and artery occlusion. Compared with groin access, radial artery catheterization has been shown to confer a lower risk of local neurovascular complications and improved quality-of-life metrics. This book is the first of its kind, detailing step by step all the technical nuances of the transradial approach in the neurointerventional world, from diagnostic cerebral angiograms to neurointerventional procedures. This is the perfect book for physicians who decided to make the transition of their practice to transradial.

scholarly journals Incidence of delayed angiographic femoral artery complications using the EXOSEAL vascular closure device

2015 ◽  
Vol 21 (3) ◽  
pp. 401-406 ◽  
Author(s):  
Ramesh Grandhi ◽  
Xiaoran Zhang ◽  
David Panczykowski ◽  
Phillip Choi ◽  
Christopher T Hunnicutt ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Vascular Complications ◽  
Arterial Puncture ◽  
Closure Device ◽  
Arterial Access ◽  
Vascular Closure Devices ◽  
Study Population ◽  
Clinically Significant ◽  
Angiographic Findings

Background and purpose Femoral artery injuries are known complications of percutaneous vascular closure devices (VCDs). We studied the incidence of delayed femoral artery angiographic irregularities after neurointerventional procedures in which the EXOSEAL extravascular closure device was used for femoral arterial puncture closure. Methods Adult patients who underwent femoral arterial puncture closures with an EXOSEAL VCD and had a follow-up femoral artery angiogram from June 2012 through August 2013 were reviewed. A blinded radiologist compared pre-deployment and follow-up femoral arteriograms for the presence of femoral artery stenosis, dissection, pseudoaneurysm, or development of an arteriovenous fistula. Hospital records were reviewed for major or minor complications of the groin site or femoral artery. Results The EXOSEAL VCD achieved hemostasis, without evidence of a groin hematoma or requiring subsequent prolonged manual compression, in 400 of 441 closures following transfemoral arterial access, representing a device success rate of 90.7%. A total of 98 patients underwent 102 repeat angiograms following closure with the EXOSEAL VCD. The average time to the repeat angiogram was 73.5 days (range 0–488, median 28). Follow-up femoral arteriography demonstrated an irregularity in seven cases, all of which were vessel stenoses of <50%. There were no dissections, pseudoaneurysms, infections, or ischemic events in the study population. Conclusions Angiographic irregularities were seen in 6.86% of cases after closure with the EXOSEAL VCD. There were no clinically significant vascular complications. Thus, femoral artery closure with EXOSEAL carries a low risk of clinically significant delayed angiographic findings.

scholarly journals Distal radial artery: The last extreme rescue arterial access for interventional radiologists?

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882391 ◽  
Author(s):  
Andrea Boncoraglio ◽  
Giuseppe Caltabiano ◽  
Pietro Valerio Foti ◽  
Luca Mammino ◽  
Giovanni Failla ◽  
...  
Keyword(s):  
High Risk ◽  
Lower Risk ◽  
Pectoralis Major Muscle ◽  
Vascular Complications ◽  
Patient Comfort ◽  
Intestinal Bleeding ◽  
Absolute Contraindication ◽  
Arterial Access ◽  
Risk Of Bleeding ◽  
Distal Radial Artery

Transradial artery approach as primary access for transcatheter diagnosis and intervention is associated with lower risk of bleeding and major vascular complications, improved patient comfort and shorter time to hemostasis and ambulation than femoral one. Patient’s adequate hand collateral perfusion, assessed by the Barbeau test, must be depicted prior to transradial artery approach in order to assess any absolute contraindication (D waveform). We describe the distal transradial artery approach, recently proposed for coronary interventions, used in emergency to embolize an intestinal bleeding in an 84-year-old woman and a left pectoralis major muscle bleeding in an 83-year-old woman, both with high risk of bleeding for femoral approach and contraindication for transradial artery approach (Barbeau D waveform).

Abstract P281: Impact of Transradial Approach on Quality of Care for Percutaneous Coronary Intervention: A Single Center Experience

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Chuntao Wu ◽  
Duanping Liao ◽  
Anne-Marie Dyer ◽  
Helen Chen ◽  
Ian C Gilchrist
Keyword(s):  
Quality Of Care ◽  
Lower Risk ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Risk Of Bleeding ◽  
The Difference

Background: Transradial cardiac catheterization has only been used in a small fraction of percutaneous coronary intervention (PCI) procedures in the United States, despite of the evidence that it may be associated with a lower risk of bleeding and mortality following PCI compared to the transfemoral approach. Objective: To evaluate the impact of the transradial approach on adverse outcomes following PCI and its potential of being a process to improve the quality of care for PCI in a single-center practice. Methods: We compared the risks of post-procedural adverse outcomes including in-hospital mortality, bleeding, and vascular complications between the 462 transradial and the 625 transfemoral cases who had undergone PCI procedures between January 2007 and March 2009. The difference in length of stay following PCI between the two entry approaches was also examined. Results: Compared to the transfemoral approach, the transradial cardiac catheterization was associated with significantly lower risk of bleeding (2.60% (12 of 462) vs. 6.08% (38 of 625); adjusted odds ratio (aOR)=0.34, 95% confidence interval (CI): 0.17-0.68, P=0.002) and vascular complications (0% vs. 1.44% (9 of 625), P=0.01). Although the trend was that the transradial approach was associated with lower risk of in-hospital mortality, the difference was not statistically significant (0.87% (4 of 462) vs. 2.24% (14 of 625); aOR=0.55, 95% CI: 0.14-2.10, P=0.38). Transradial patients were more likely to be discharged on the same day of procedure (14.2% vs. 2.2%, P<0.0001). Conclusion: The transradial approach is related to lower risk of bleeding and vascular complications. Introducing this approach to practice could improve the quality of care for PCI.

scholarly journals Vascular Complications of Transradial Access for Cardiac Catheterization

2021 ◽  
Vol 15 ◽  
Author(s):  
Tanawan Riangwiwat ◽  
James C Blankenship
Keyword(s):  
Radial Artery ◽  
Cardiac Catheterization ◽  
Rare Complication ◽  
Vascular Complications ◽  
Daily Practice ◽  
Artery Occlusion ◽  
Prompt Treatment ◽  
Hand Ischemia ◽  
Transradial Access ◽  
Radial Artery Occlusion

Transradial access has been increasingly adopted for cardiac catheterization. It is crucial for operators to recognize potential vascular complications associated with radial artery access. Prevention, early detection, and prompt treatment of vascular complications are essential to prevent serious morbidities. This review aims to raise awareness of transradial access vascular complications. Radial artery spasm is treated with intra-arterial verapamil and/or nitroglycerine. Hemorrhagic complications, such as perforation, hematoma, arteriovenous fistula, and pseudoaneurysm, are treated with prolonged compression. Patent hemostasis and adequate anticoagulation are used to prevent radial artery occlusion. Hand ischemia is a rare complication not associated with abnormal results of the Allen or Barbeau test, and can be treated with intra-arterial verapamil, IV heparin, and IV diltiazem. Finally, an attentive monitoring protocol for the timely detection of vascular complications should be implemented in daily practice.

scholarly journals The hypoxia sensitive metal transcription factor MTF-1 activates NCX1 brain promoter and participates in remote postconditioning neuroprotection in stroke

2021 ◽  
Vol 12 (5) ◽  
Author(s):  
Valeria Valsecchi ◽  
Giusy Laudati ◽  
Ornella Cuomo ◽  
Rossana Sirabella ◽  
Lucio Annunziato ◽  
...  
Keyword(s):  
Transcription Factor ◽  
Brain Ischemia ◽  
Femoral Artery ◽  
Infarct Volume ◽  
Neuroprotective Effect ◽  
Artery Occlusion ◽  
Sodium Calcium Exchanger ◽  
Protein Levels ◽  
Relevant Role ◽  
Remote Postconditioning

AbstractRemote limb ischemic postconditioning (RLIP) is an experimental strategy in which short femoral artery ischemia reduces brain damage induced by a previous harmful ischemic insult. Ionic homeostasis maintenance in the CNS seems to play a relevant role in mediating RLIP neuroprotection and among the effectors, the sodium-calcium exchanger 1 (NCX1) may give an important contribution, being expressed in all CNS cells involved in brain ischemic pathophysiology. The aim of this work was to investigate whether the metal responsive transcription factor 1 (MTF-1), an important hypoxia sensitive transcription factor, may (i) interact and regulate NCX1, and (ii) play a role in the neuroprotective effect mediated by RLIP through NCX1 activation. Here we demonstrated that in brain ischemia induced by transient middle cerebral occlusion (tMCAO), MTF-1 is triggered by a subsequent temporary femoral artery occlusion (FAO) and represents a mediator of endogenous neuroprotection. More importantly, we showed that MTF-1 translocates to the nucleus where it binds the metal responsive element (MRE) located at −23/−17 bp of Ncx1 brain promoter thus activating its transcription and inducing an upregulation of NCX1 that has been demonstrated to be neuroprotective. Furthermore, RLIP restored MTF-1 and NCX1 protein levels in the ischemic rat brain cortex and the silencing of MTF-1 prevented the increase of NCX1 observed in RLIP protected rats, thus demonstrating a direct regulation of NCX1 by MTF-1 in the ischemic cortex of rat exposed to tMCAO followed by FAO. Moreover, silencing of MTF-1 significantly reduced the neuroprotective effect elicited by RLIP as demonstrated by the enlargement of brain infarct volume observed in rats subjected to RLIP and treated with MTF-1 silencing. Overall, MTF-dependent activation of NCX1 and their upregulation elicited by RLIP, besides unraveling a new molecular pathway of neuroprotection during brain ischemia, might represent an additional mechanism to intervene in stroke pathophysiology.

scholarly journals Managing vascular access and closure for percutaneous mechanical circulatory support

2021 ◽  
Vol 23 (Supplement_A) ◽  
pp. A10-A14
Author(s):  
Konstantinos Karatolios ◽  
Patrick Hunziker ◽  
David Schibilsky
Keyword(s):  
Mechanical Circulatory Support ◽  
Axillary Artery ◽  
Vascular Complications ◽  
Vascular Trauma ◽  
Circulatory Support ◽  
Femoral Access ◽  
Arterial Access ◽  
Femoral Arterial Access ◽  
Artery Disease ◽  
Critical Aspects

Abstract Even with current generation mechanical circulatory support (MCS) devices, vascular complications are still considerable risks in MCS that influence patients’ recovery and survival. Hence, efforts are made to reduce vascular trauma and obtaining safe and adequate arterial access using state-of-the-art techniques is one of the most critical aspects for optimizing the outcomes and efficiency of percutaneous MCS. Femoral arterial access remains necessary for numerous large-bore access procedures and is most commonly used for MCS, whereas percutaneous axillary artery access is typically considered an alternative for the delivery of MCS, especially in patients with severe peripheral artery disease. This article will address the access, maintenance, closure and complication management of large-bore femoral access and concisely describe alternative access routes.

Acute compensation to abrupt occlusion of rat femoral artery is prevented by NO synthase inhibitors

1994 ◽  
Vol 267 (6) ◽  
pp. H2523-H2530 ◽  
Author(s):  
J. L. Unthank ◽  
J. C. Nixon ◽  
M. C. Dalsing
Keyword(s):  
Femoral Artery ◽  
Arterial Occlusion ◽  
Artery Occlusion ◽  
No Synthase ◽  
Artery Blood Flow ◽  
Relaxing Factor ◽  
Femoral Artery Occlusion ◽  
Before And After ◽  
Endothelium Derived Relaxing Factor ◽  
Oxide Synthase

The hemodynamic significance of endothelium-derived relaxing factor (EDRF)-mediated mechanisms in vascular responses to abrupt rat femoral artery occlusion was investigated. Temporary arterial occlusion was produced before and after inhibition of nitric oxide synthase by N omega-nitro-L-arginine methyl ester (L-NAME) or NG-monomethyl-L-arginine (L-NMMA). Iliac artery blood flow and arterial pressures proximal and distal to the occlusion were measured. Normal vascular compensation included a return of resistance to preocclusion levels and a rise in distal pressure to a plateau within 5 min postocclusion. After treatment with L-NAME and L-NMMA, postocclusion resistance remained elevated by 53 and 36%, respectively. Collateral dilation after occlusion, as indicated by the rise in distal pressure, was prevented by L-NAME but not L-NMMA. Increases in adrenergic tone and mean arterial pressure by phenylephrine did not prevent compensation, suggesting the effects of L-NAME and L-NMMA did not result from elevated sympathetic activation or pressure. The results are consistent with the hypothesis that the stimulated release of endothelium-derived relaxing factor mediates the acute vascular compensation to abrupt arterial occlusion.

P2Y12 inhibitors for the neurointerventionalist

2021 ◽  
pp. 159101992110150
Author(s):  
Robin J Borchert ◽  
Davide Simonato ◽  
Charlotte R Hickman ◽  
Maurizio Fuschi ◽  
Lucie Thibault ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
Individual Characteristics ◽  
Onset Of Action ◽  
P2y12 Inhibitors ◽  
Hemorrhagic Complications ◽  
The Individual ◽  
Neurointerventional Procedures

The use of antiplatelets is widespread in clinical practice. However, for neurointerventional procedures, protocols for antiplatelet use are scarce and practice varies between individuals and institutions. This is further complicated by the quantity of antiplatelet agents which differ in route of administration, dosage, onset of action, efficacy and ischemic and hemorrhagic complications. Clarifying the individual characteristics for each antiplatelet agent, and their associated risks, will increasingly become relevant as the practice of mechanical thrombectomy, stenting, coiling and flow diversion procedures grows. The aim of this review is to summarize the existing literature for the use of P2Y12 inhibitors in neurointerventional procedures, examine the quality of the evidence, and highlight areas in need of further research.

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