Manual reduction of a radial artery loop under direct fluoroscopic visualization

2021 ◽  
Vol 14 (9) ◽  
pp. 1-4
Author(s):  
Evan Luther ◽  
Eric Huang ◽  
Hunter King ◽  
Michael Silva ◽  
Joshua Burks ◽  
...  
Keyword(s):  
Radial Artery ◽  
Carotid Body ◽  
Preoperative Embolization ◽  
Access Site ◽  
Antecubital Fossa ◽  
Femoral Access ◽  
Manual Reduction ◽  
Guide Catheter ◽  
Manual Manipulation ◽  
Standard Techniques

Transradial access (TRA) has become increasingly utilized in neurointerventions because it reduces access site complications. However, radial artery anomalies can be difficult to navigate, often necessitating conversion to femoral access. We describe the case of a female patient in her early 70s who underwent preoperative embolization of a carotid body tumor via right TRA. Her radial angiogram demonstrated the presence of a radial artery loop which was successfully navigated with a triaxial system but would not spontaneously reduce, even after the guide catheter was advanced into the subclavian artery. However, manual manipulation of the catheters in the antecubital fossa under direct fluoroscopic visualization reduced the loop, allowing the procedure to continue transradially. Although most radial loops can be traversed and reduced using standard techniques, this case demonstrates that manual reduction can be successful when other measures fail. We recommend attempting this method prior to converting the access site.

Republished: Manual reduction of a radial artery loop under direct fluoroscopic visualization

2021 ◽  
pp. neurintsurg-2021-017665.rep
Author(s):  
Evan Luther ◽  
Eric Huang ◽  
Hunter King ◽  
Michael Silva ◽  
Joshua Burks ◽  
...  
Keyword(s):  
Radial Artery ◽  
Preoperative Embolization ◽  
Access Site ◽  
Antecubital Fossa ◽  
Femoral Access ◽  
Manual Reduction ◽  
Transradial Access ◽  
Guide Catheter ◽  
Manual Manipulation ◽  
Standard Techniques

Transradial access has become increasingly used in neurointerventions because it reduces access site complications. However, radial artery anomalies can be difficult to navigate, often necessitating conversion to femoral access. We describe the case of a female patient in her early 70 s who underwent preoperative embolization of a carotid body tumor via right transradial access. Her radial angiogram demonstrated the presence of a radial artery loop which was successfully navigated with a triaxial system but would not spontaneously reduce even after the guide catheter was advanced into the subclavian artery. However, manual manipulation of the catheters in the antecubital fossa under direct fluoroscopic visualization reduced the loop allowing the procedure to continue transradially. Although a majority of radial loops can be traversed and reduced using standard techniques, this case demonstrates that manual reduction can be successful when other measures fail. We recommend attempting this method before converting the access site.

Use of Walrus balloon-guide catheter through sheathless radial approach for mechanical thrombectomy of right middle cerebral artery occlusion

2021 ◽  
pp. neurintsurg-2021-017985
Author(s):  
Rimal H Dossani ◽  
Muhammad Waqas ◽  
Hamid H Rai ◽  
Andre Monteiro ◽  
Faisal Almayman ◽  
...  
Keyword(s):  
Radial Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Femoral Access ◽  
Content Type ◽  
Radial Approach ◽  
Guide Catheter ◽  
Ct Angiogram ◽  
History Of ◽  
Video Player

The literature demonstrates a favorable first pass effect with balloon-guide catheter (BGC) for mechanical thrombectomy. An 8F BGC is routinely used with femoral access. We present the first video report of 8F BGC advanced through the radial artery using a sheathless technique (video 1). An approximately 70-year-old patient presented with left-sided hemiplegia, neglect, and dysarthria. A CT angiogram demonstrated right M1 occlusion, and the patient underwent urgent mechanical thrombectomy. Radial approach was preferred owing to patient history of anticoagulation. A 6F Sim Select intermediate catheter was used to minimize the step off as the 8F BGC was advanced into the radial artery over an 035 exchange-length Advantage Glidewire. A skin nick over the Glidewire Advantage facilitated the introduction of the 8F BGC into the radial artery. Standard mechanical thrombectomy using a combination of stent retriever and aspiration catheter (Solumbra technique) was performed, and thrombolysis in cerebral infarction 3 recanalization was achieved after a single pass. The National Institutes of Health Scale score improved from 12 to 4, with mild left facial droop, dysarthria, and decreased speech fluency. The patient was discharged from the hospital on postoperative day 2. Ultrasound should be used for immediate assessment of radial artery size and conversion to femoral access without delay if the radial artery is less than 2.5 mm.Video 1

Abstract 16146: Topical Nitroglycerine Reduces Radial Access Site Failure and Femoral Crossover - Topical Nitroglycerine to Prevent Radial Artery Spasm (TNTRASP) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Prabhakaran P Gopalakrishnan ◽  
Manova David ◽  
Pradeep Manoharan ◽  
Sharan Rufus Ponniah ◽  
Brendan Duffy
Keyword(s):  
Radiation Dose ◽  
Radial Artery ◽  
Drug Application ◽  
Sectional Area ◽  
Access Site ◽  
Cross Sectional ◽  
Femoral Access ◽  
Topical Lidocaine ◽  
Increased Risk ◽  
Reduced Risk

Background: Radial to femoral access crossover has been reported as high as 7.6%. Access site failure, radial spasm and tortuosity are potential reasons. Methods: Patients undergoing radial catheterization were randomly assigned to 30 mg of topical nitroglycerine (NTG, n =48) or placebo ( n =52) at least one hour before access. Both groups received 40 mg of topical lidocaine. Radial artery dimensions were measured before drug application and immediately before access. RASP score (Forearm discomfort + Difficult catheter manipulation + Additional intraarterial NTG + Sheath removal difficulty) >0 indicates radial spasm. Results: Radial artery cross sectional area (CSA) increased significantly in NTG group (30% vs. -3%, p <0.001). Radial artery was smaller than the sheath at time of access in fewer patients in NTG group (10% vs. 27%, p <0.05). Fewer patients had spasm in NTG group (17% vs. 29%, p =0.14). Average RASP score was lower in NTG group (0.2 vs. 0.6, p =0.10). No crossover to femoral access in NTG group compared to 4 crossovers in control ( p <0.05). Femoral crossover was 10 times more likely if radial diameter < 2 mm ( p <0.05). Risk of radial spasm was higher with multiple arterial sticks ( p <0.01); arterial tortuosity ( p <0.05); intraarterial heparin ( p <0.01), use of multiple wires ( p <0.001); use of multiple catheters ( p <0.01) and nonhydrophillic catheter use ( p =0.001). Preprocedural valium reduced risk of radial spasm. Radial spasm was associated with 5 fold risk of hematoma ( p =0.01) and higher radiation dose ( p <0.001). Discussion: Pre-dilation with topical NTG reduced access site failure and risk of femoral crossover. Radial spasm incidence was lower in NTG but not statistically significant. Radial spasm was influenced by several factors like choice of wires and catheters. Radial spasm increased risk of hematoma as well as radiation exposure. Conclusion: Topical nitroglycerine to predilate radial artery reduces risk of femoral crossover and may reduce radial spasm.

Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis

2019 ◽  
Vol 12 (1) ◽  
pp. 87-93 ◽  
Author(s):  
Tanaporn Jaroenngarmsamer ◽  
Kartik Dev Bhatia ◽  
Hans Kortman ◽  
Emanuele Orru ◽  
Timo Krings
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Radial Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Minor Stroke ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
Procedural Success

BackgroundFemoral access is the traditional approach for endovascular carotid artery stenting. Radial access is increasingly used as an alternative approach due to its known anatomical advantages in patients with unfavorable aortic arch morphology via the femoral approach and its excellent access site safety profile. Our objective was to analyze procedural success using radial access for carotid artery stenting as reported in the literature.MethodsThree online databases were systematically searched following PRISMA guidelines for studies (n ≥20) using radial artery access for carotid artery stenting (1999–2018). Random-effects meta-analysis was used to pool the procedural success (successful stent placement with no requirement for crossover to femoral access), mortality, and complication rates associated with radial access.ResultsSeven eligible studies reported procedural success outcomes with a pooled meta-analysis rate of 90.8% (657/723; 95% CI 86.7% to 94.2%; I2=53.1%). Asymptomatic radial artery occlusion occurred in 5.9% (95% CI 4.1% to 8.0%; I2=0%) and forearm hematoma in 1.4% (95% CI 0.4% to 2.9%; I2=0%). Risk of minor stroke/transient ischemic attack was 1.9% (95% CI 0.6% to 3.8%; I2=42.3%) and major stroke was 1.0% (95% CI 0.4% to 1.8%; I2=0%). There were three deaths across the seven studies (0.6%; 95% CI 0.2% to 1.3%; I2=0%). The meta-analysis was limited by statistically significant heterogeneity for the primary outcome of procedural success.ConclusionRadial access for carotid artery stenting has a high procedural success rate with low rates of mortality, access site complications, and cerebrovascular complications. The potential benefits of this approach in patients with unfavorable aortic arch access should be explored in a prospective randomized trial.

Transradial intraoperative cerebral angiography: a multicenter case series and technical report

2019 ◽  
Vol 12 (2) ◽  
pp. 170-175
Author(s):  
Joshua W Osbun ◽  
Bhuvic Patel ◽  
Michael R Levitt ◽  
Alexander T Yahanda ◽  
Amar Shah ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Carotid Arteries ◽  
Case Series ◽  
Patient Positioning ◽  
Interventional Cardiology ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Access Site Complication

BackgroundUse of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative cerebral angiography.ObjectiveTo report a multicenter experience on the use of radial artery access in intraoperative cerebral angiography, including case series and discussion of technical nuances.Methods27 patients underwent attempted transradial cerebral angiography betweenMay 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications.Results24 of the 27 patients (88.8%) underwent successful transradial intraoperative cerebral angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication.ConclusionsTransradial intraoperative cerebral angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.

Use of a sheathless 8-French balloon guide catheter (Walrus) through the radial artery for mechanical thrombectomy: technique and case series

2021 ◽  
pp. neurintsurg-2021-017868
Author(s):  
Rimal H Dossani ◽  
Muhammad Waqas ◽  
Andre Monteiro ◽  
Justin M Cappuzzo ◽  
Faisal Almayman ◽  
...  
Keyword(s):  
Radial Artery ◽  
Mechanical Thrombectomy ◽  
Descriptive Analysis ◽  
Case Series ◽  
Retrospective Case ◽  
Access Site ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Transradial Access ◽  
Guide Catheter

BackgroundThe effectiveness of transradial stroke thrombectomy has been limited by guide catheter size and lack of good balloon options. In this study we describe our technique for the use of a sheathless 8-French balloon guide catheter (Walrus) through radial access and present our initial clinical experience.MethodsThis was a retrospective case series of consecutive patients who underwent mechanical thrombectomy for large vessel occlusion using the sheathless catheter over a period of 3 months. Clinical characteristics, procedural details, reperfusion success (modified Thrombolysis in Cerebral Infarction (mTICI) 2b–3 grade), first-pass effect (FPE; mTICI reperfusion grade 2c or 3 with a single pass), access site complications and clinical improvement at discharge were recorded. A descriptive analysis was performed.ResultsAmong the 10 patients in the series, median age was 77 years (IQR 75–79) and three were women. All patients had a baseline modified Rankin Scale score ≤2. Median admission National Institutes of Health Stroke Scale (NIHSS) score was 12.5 (IQR 9–16). Four patients received intravenous alteplase before mechanical thrombectomy. Eight patients had M1 occlusion and two had proximal M2 occlusion. The median radial artery diameter was 2.5 mm (IQR 2.5–2.7). Successful reperfusion was achieved in all patients. FPE was achieved in six patients. No access site-related complications or post-procedural intracranial hemorrhages occurred. All patients had improvement in NIHSS score at discharge.ConclusionsThe use of this sheathless catheter for transradial access was safe and feasible. The technique can potentially improve the outcomes of transradial access for stroke intervention.

P4703Distal radial artery access using slender technique for superfitial femoral artery intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Ruzsa ◽  
B Nemes ◽  
V Orias ◽  
A Csuhajda ◽  
P Sotonyi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Radial Artery ◽  
Femoral Artery ◽  
Technical Success ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Duration Of Hospitalization ◽  
Angiographic Data ◽  
Acute Success

Abstract Purpose The purpose of this pilot study was to evaluate the acute success and complication rate of the distal radial artery access for femoral artery intervention. Methods and results The clinical and angiographic data of 195 consecutive cases with symptomatic superficial femoral stenosis, treated via distal radial (DR) or proximal radial (PR) access using 6F sheathless guiding between 2014 and 2018, were evaluated in a pilot study. Secondary access was achieved through the pedal artery. Primary endpoint: major adverse events (MAE), rate of major and minor access site complications. Secondary endpoints: angiographic outcome, procedural factors, cross-over rate to femoral access site, and duration of hospitalization. Overall technical success was achieved in 186 patients (95.4%) with 25/26 (96.1%) success in DR and 161/169 (95.2%) success in PR group (ns). The cross over rate to femoral access site was 3.8% in DR and 4.7% in PR group (ns), while dual (transradial and transpedal) access was used in 9/26 (34.6%) patients in DR and 39/169 (23%) patients in PR group (p<0.05). Stent implantation was necessary in 8/26 (30.7%) cases in DR and in 42/169 (24.8%) cases in PR group (ns). CTO recanalization was performed in the DR and PR group with 94.1% (16/17) and 92.6% (79/81) technical success rate. The mean contrast consumption, fluoroscopy time and procedure time was in the DR and PR group was: 93.4 [78–108]ml vs 120 [108–131]ml, 662 [501–822]vs 769 [671–866]min, and 33.4 [27–39]vs 36.5 [32–40]min (ns), respectively. The rate of access site complications in the DR and PR group was 0% and 4.7% (0% major, 4.7% minor) (p p<0.001), respectively. The cumulative incidence of MAE at 3 months in the DR and PR group was 3.8% vs 10.6% (p<0.05). Conclusion Femoral artery intervention can be safely and effectively performed using distal transradial access and distal radial access is associated with lower access site complications.

Access-site complications of the transradial approach: Rare but still there.

2020 ◽  
Vol 16 ◽  
Author(s):  
Stelina Alkagiet ◽  
Dimitrios Petroglou ◽  
Dimitrios N. Nikas ◽  
Theofilos M. Kolettis
Keyword(s):  
Radial Artery ◽  
Artery Occlusion ◽  
Tissue Loss ◽  
Access Site ◽  
Transradial Approach ◽  
Financial Benefits ◽  
Eversion Endarterectomy ◽  
Life Threatening ◽  
Sheath Insertion ◽  
Venous Fistula

: In the past decade, the Transradial Approach (TRA) has constantly gained ground among interventional cardiologists. TRA's anatomical advantages, in addition to patients' acceptance and financial benefits, due to rapid patient mobilization and shorter hospital stay, made it the default approach in most catheterization laboratories. Access-site complications of TRA are rare, and usually of little clinical impact, thus they are often overlooked and underdiagnosed. Radial Artery Occlusion (RAO) is the most common, followed by radial artery spasm, perforation, hemorrhagic complications, pseudoaneurysm, arterio-venous fistula and even rarer complications, such as nerve injury, sterile granuloma, eversion endarterectomy or skin necrosis. Most of them are conservatively treated, but rarely, surgical treatment may be needed and late diagnosis may lead to life-threatening situations, such as hand ischemia or compartment syndrome and tissue loss. Additionally, some complications may eventually lead to TRA failure and switch to a different approach. On the other hand, it is the opinion of the authors that non-occlusive radial artery injury, commonly included in TRA's complications in the literature, should be regarded more as an anticipated functional and anatomical cascade, following radial artery puncture and sheath insertion.

scholarly journals Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zahn ◽  
M Hochadel ◽  
B Schumacher ◽  
M Pauschinger ◽  
C Stellbrink ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Strong Variation ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
St Elevation ◽  
The Difference

Abstract Background Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts. Methods We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access. Results Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend &lt;0.0001 with a strong variation between the participating centres (0% to 37%). Conclusions Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p&lt;0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution. Funding Acknowledgement Type of funding source: None

scholarly journals Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room: An Instant Operator Risk Chart for Daily Practice

2021 ◽  
pp. 152660282110074
Author(s):  
Quirina M. B. de Ruiter ◽  
Frans L. Moll ◽  
Constantijn E. V. B. Hazenberg ◽  
Joost A. van Herwaarden
Keyword(s):  
Radiation Dose ◽  
Dose Rate ◽  
Effect Size ◽  
Radiation Risk ◽  
Dose Limit ◽  
Access Site ◽  
Femoral Access ◽  
Dose Rates ◽  
Rate Prediction ◽  
Operator Dose

Introduction: While the operator radiation dose rates are correlated to patient radiation dose rates, discrepancies may exist in the effect size of each individual radiation dose predictors. An operator dose rate prediction model was developed, compared with the patient dose rate prediction model, and converted to an instant operator risk chart. Materials and Methods: The radiation dose rates (DRoperator for the operator and DRpatient for the patient) from 12,865 abdomen X-ray acquisitions were selected from 50 unique patients undergoing standard or complex endovascular aortic repair (EVAR) in the hybrid operating room with a fixed C-arm. The radiation dose rates were analyzed using a log-linear multivariable mixed model (with the patient as the random effect) and incorporated varying (patient and C-arm) radiation dose predictors combined with the vascular access site. The operator dose rate models were used to predict the expected radiation exposure duration until an operator may be at risk to reach the 20 mSv year dose limit. The dose rate prediction models were translated into an instant operator radiation risk chart. Results: In the multivariate patient and operator fluoroscopy dose rate models, lower DRoperator than DRpatient effect size was found for radiation protocol (2.06 for patient vs 1.4 for operator changing from low to medium protocol) and C-arm angulation. Comparable effect sizes for both DRoperator and DRpatient were found for body mass index (1.25 for patient and 1.27 for the operator) and irradiated field. A higher effect size for the DRoperator than DRpatient was found for C-arm rotation (1.24 for the patient vs 1.69 for the operator) and exchanging from femoral access site to brachial access (1.05 for patient vs 2.5 for the operator). Operators may reach their yearly 20 mSv year dose limit after 941 minutes from the femoral access vs 358 minutes of digital subtraction angiography radiation from the brachial access. Conclusion: The operator dose rates were correlated to patient dose rate; however, C-arm angulation and changing from femoral to brachial vascular access site may disproportionally increase the operator radiation risk compared with the patient radiation risk. An instant risk chart may improve operator dose awareness during EVAR.

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