Incorporation of transradial approach in neuroendovascular procedures: defining benchmarks for rates of complications and conversion to femoral access

2020 ◽  
Vol 12 (11) ◽  
pp. 1122-1126 ◽  
Author(s):  
Eyad Almallouhi ◽  
Sami Al Kasab ◽  
Mithun G Sattur ◽  
Jonathan Lena ◽  
Pascal M Jabbour ◽  
...  
Keyword(s):  
Interventional Procedures ◽  
Early Stage ◽  
Diagnostic Procedures ◽  
Complication Rates ◽  
Access Site ◽  
Femoral Access ◽  
Transradial Approach ◽  
Wide Range ◽  
The Usa ◽  
Baseline Characteristics

BackgroundThe transradial approach (TRA) has gained increasing popularity for neuroendovascular procedures. However, the experience with TRA in neuroangiography is still in early stages in most centers, and the safety and feasibility of this approach have not been well established. The purpose of this study is to report the safety and feasibility of TRA for neuroendovascular procedures.MethodsWe reviewed charts from six institutions in the USA to include consecutive patients who underwent diagnostic or interventional neuroendovascular procedures through TRA from July 2018 to July 2019. Collected data included baseline characteristics, procedural variables, complications, and whether there was a crossover to transfemoral access.ResultsA total of 2203 patients were included in the study (age 56.1±15.2, 60.8% women). Of these, 1697 (77%) patients underwent diagnostic procedures and 506 (23%) underwent interventional procedures. Successfully completed procedures included aneurysm coiling (n=97), flow diversion (n=89), stent-assisted coiling (n=57), balloon-assisted coiling (n=19), and stroke thrombectomy (n=76). Crossover to femoral access was required in 114 (5.2%). There were no major complications related to the radial access site. Minor complications related to access site were seen in 14 (0.6%) patients.ConclusionIn this early stage of transforming to the ‘radial-first’ approach for neuroendovascular procedures, TRA was safe with low complication rates for both diagnostic and interventional procedures. A wide range of procedures were completed successfully using TRA.

Abstract 64: Transradial Approach: The Future of Neurointervention-A Muticenter Collaboration

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Eyad Almallouhi ◽  
Sami Al Kasab ◽  
Robert Starke ◽  
Jonathan R Lena ◽  
Ahmad Sweid ◽  
...  
Keyword(s):  
Interventional Procedures ◽  
Early Stage ◽  
Major Complication ◽  
High Volume ◽  
The United States ◽  
Access Site ◽  
Femoral Access ◽  
Transradial Approach ◽  
Wide Range ◽  
Forearm Pain

Introduction: Transradial approach (TRA) has gained significant popularity in the neuroendovascular world over the past few years. The purpose of this study is to report early experience in TRA from high volume centers. Methods: We reviewed charts from 4 institutions in the United States to include consecutive patients who underwent diagnostic or interventional neuroendovascular procedure through TRA from July 2018 to July 2019. Collected data included baseline characteristics, procedural variables, whether there was crossover to transfemoral access and complications. Results: A total of 1272 patients were included in the series (age 57.2 ± 15.3, 46.3% females). Out of those, 1054 (82.9%) patients underwent diagnostic cerebral angiograms and 218 (17.1%) underwent interventional procedures. Successfully completed procedures included aneurysm primary coiling (62 patients), stent assisted coiling (44 patients), flow diversion (40 patients), balloon assisted coiling (21 patients), and stroke thrombectomy (24 patients). The large vessels were selected as following: right vertebral artery (VA) in 74.2% of the cases, right internal carotid artery (ICA) in 75.4% of the cases, left VA in 51.4% of the cases, left ICA in 69.1% of the cases. Crossover to femoral access was required in 82 (6.4%) patients (most common cause was inability to reach the target vessel in 13 patients). None of the included patients had major complication related to the access site. Minor complications related to access site were seen in 30 (2.4%) patients. Of those, 11 patients had forearm hematoma, 8 had mild-moderate vasospasm, 6 had forearm pain, and 5 had oozing from the access site. Conclusion: In this early stage of transforming to radial-first approach for neurointerventions, TRA was reasonably safe with relatively low complication rate for both diagnostic and interventional procedures. Wide range of procedures were completed successfully using TRA.

scholarly journals Lower complication rates associated with transradial versus transfemoral flow diverting stent placement

2020 ◽  
Vol 13 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Yangchun Li ◽  
Stephanie H Chen ◽  
Alejandro M Spiotta ◽  
Pascal Jabbour ◽  
Michael R Levitt ◽  
...  
Keyword(s):  
Complication Rate ◽  
Large Scale ◽  
Cerebral Aneurysms ◽  
Pooled Analysis ◽  
Flow Diversion ◽  
Complication Rates ◽  
Access Site ◽  
Femoral Access ◽  
Access Site Complication ◽  
Wide Range

BackgroundCurrently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion.MethodsWe retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches.ResultsA total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035).ConclusionTRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series.

TRIACCESS Study: Randomized Comparison Between Radial, Femoral, and Pedal Access for Percutaneous Femoro-popliteal Artery Angioplasty

2021 ◽  
pp. 152660282110385
Author(s):  
Zoltán Ruzsa ◽  
Ádám Csavajda ◽  
István Hizoh ◽  
Mónika Deák ◽  
Péter Sótonyi ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Cumulative Incidence ◽  
Randomized Study ◽  
Artery Stenosis ◽  
Complication Rates ◽  
Access Site ◽  
Total Occlusion ◽  
Femoral Access ◽  
X Ray ◽  
Access Site Complication

Background The aim of this randomized study was to compare the success and complication rates of different access sites for the treatment of superficial artery stenosis. Methods and Results A total of 180 consecutive patients were randomized in a prospective study to treat symptomatic superficial femoral artery stenosis via radial (RA), femoral (FA), or pedal artery (PA) access. Technical success was achieved in 96.7%, 100%, and 100% of the patients in the RA, FA, and PA groups, respectively (p=0.33). Secondary access sites were used in 30%, 3.3%, and 30% of the patients in the RA, FA, and PA access groups, respectively (p=0.0002). Recanalization for chronic total occlusion was performed in 34/36 (94.4%), 30/30 (100%), and 46/46 (100%) patients in the RA, FA, and PA groups, respectively (p=0.17). The X-ray dose was significantly lower in the PA group than that in the RA and FA access groups (63.1 vs 162 vs 153 Dyn, p=0.0004). The cumulative rates of access site complications in the RA, FA, and PA groups were 3.3% (0% major and 3.3% minor), 16.7% (3.3% major and 13.3% minor), and 3.3% (3.3% major and 0% minor) (p=0.0085), respectively. The cumulative incidence of MACEs at 6 months in the RA, FA, and PA groups was 5%, 6.7%, and 1.7%, respectively. The cumulative incidence of MALEs at 6 months in the RA, FA, and PA groups was 20%, 16.7%, and 9.2%, respectively (p=0.54). Conclusion Femoral artery intervention can be safely and effectively performed using radial, femoral, and pedal access, but radial and pedal access is associated with a lower access site complication rate and hospitalization. Pedal access is associated with a lower X-ray dose than that with radial and femoral access.

scholarly journals Usefulness of a Nonsuture Closure Device in Patients Undergoing Diagnostic Coronary and Peripheral Angiography

2017 ◽  
Vol 26 (04) ◽  
pp. 228-233
Author(s):  
John Owens ◽  
Shaun Bhatty ◽  
Robert Donovan ◽  
Andrea Tordini ◽  
Peter Danyi ◽  
...  
Keyword(s):  
Closure Device ◽  
Complication Rates ◽  
Manual Compression ◽  
Access Site ◽  
Femoral Access ◽  
Peripheral Angiography ◽  
Major Complications ◽  
Increased Risk ◽  
Male Patients ◽  
To Receive

AbstractVascular access site complications can follow diagnostic coronary and peripheral angiography. We compared the complication rates of the Catalyst vascular closure device, with the complication rates after manual compression in patients undergoing diagnostic angiographic procedures via femoral access. We studied 1,470 predominantly male patients undergoing diagnostic coronary and peripheral angiography. Catalyst closure devices were used in 436 (29.7%) patients and manual compression was used in 1,034 (70.3%) patients. The former were allowed to ambulate after 2 hours, while the latter were allowed to ambulate after 6 hours. Major complications occurred in 4 (0.9%) patients who had a Catalyst device and in 14 (1.4%) patients who had manual compression (odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.22–2.1, p = 0.49). Any complications occurred in 51 (11.7%) patients who had a Catalyst closure device and in 64 (6.2%) patients who had manual compression (OR: 2, CI: 1.4–3, p < 0.01). After adjustment for other variables and for a propensity score reflecting the probability to receive the closure device, the association of major complications with the use of the closure device remained not significant (OR: 0.54, 95% CI: 0.17–1.7, p = 0.29), while the association of any complications with the use of the Catalyst device remained significant (OR: 1.9, 95% CI: 1.3–2.9, p < 0.01). The Catalyst device was not associated with an increased risk of major groin complications but was associated with an increased risk of any complications compared with manual compression. Patients receiving the closure device ambulated sooner.

From Femoral to Radial Approach in Coronary Intervention

Angiology ◽  
2016 ◽  
Vol 68 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Renatomaria Bianchi ◽  
Ludovica D’Acierno ◽  
Mario Crisci ◽  
Donato Tartaglione ◽  
Maurizio Cappelli Bigazzi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
Access Site ◽  
Femoral Access ◽  
Transradial Approach ◽  
Operator Experience ◽  
Transradial Access ◽  
Hemorrhagic Events ◽  
Duration Of Hospitalization

Since the first cardiac catheterization in 1929, this procedure has evolved considerably. Historically performed via the transfemoral access, in the last years, the transradial access has been spreading gradually due to its many advantages. We have conducted a review of published literature concerning efficacy, safety, and cost-effectiveness, and we analyzed our patients’ data, including the results of the recently published Minimizing Adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX (MATRIX) study. This review confirmed the superiority of the transradial access compared to the femoral access, especially regarding complications related to the access site, duration of hospitalization, and comfort for the patient. The transradial approach is an excellent option for coronary angiography, and the procedure’s risks are reduced by increased operator experience.

Outcomes of Radial Versus Femoral Approach in Patients with St Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Emad Torkey ◽  
Mohamed Sanhoury ◽  
Mohammad Sadaka ◽  
Amr Zaki
Keyword(s):  
Hospital Stay ◽  
Anticoagulation Therapy ◽  
Vascular Complications ◽  
University Hospital ◽  
P Value ◽  
Access Site ◽  
Transfemoral Approach ◽  
Femoral Access ◽  
Transradial Approach ◽  
Procedural Time

Abstract Aim of the work To compare transradial and transfemoral approaches in 1ry and rescue PCI for STEMI. Methods This prospective observational study was done at Alexandria University Hospital and International Cardiac Center from January 2020 to August 2020 by recruiting every patient had met our inclusion criteria (the third universal definition of MI) admitted to the coronary care unit after doing primary or rescue PCI 200 patients were involved. Exclusion criteria were (Thrombophilia and thrombocytopenia, known hematological abnormalities, and patients with known sever peripheral vascular disease. Randomization made by a computer-generated program into two equal parallel groups that were randomly assigned to either Radial access approach or femoral access approach for primary or rescue PCI. Chest pain to time of first medical contact (FMC), and the procedural time were computed. Coronary angiography and PCI procedure were described including materials used and the intra-procedure complications. MACE (Major Adverse Cardiac Events) or other hemodynamic complications were documented. All the patients were contacted for follow up to 6 months after the procedure by interviewing with the patients via telephone or the responsible physician to determine the outcomes procedure. Results The distribution of demographic variables and risk factors were similar among 200 patients in the radial and femoral groups. There had been significant differences between the groups concerning the primary end point MACE after 6 months in favor of radial group patients with p value (0.004), there was significant deference between the two studied groups concerning the total bleeding complication with higher risk in femoral group 11% compared to radial group 3% with P value (0.02). Despite the nearly equal mean time from pain to FMC (9.01 hours in radial group and 9.2 hours in femoral group), the total procedural time was significantly longer in radial group compared to femoral group with (p value 0.037). However the rate of non-culprit vessel revascularsation was significantly higher in radial group 17% compared to 6% in femoral group with p value of (0.015). In-hospital stay was significantly shorter in the radial group patients P value (0.02). Conclusion Transradial approach is safe, and effective with a high procedural success rate as the transfemoral approach but with lower risk for bleeding vascular complications and other access site complications as hematoma especially for patients where aggressive antiplatelet and anticoagulation therapy is needed, or patients who are expected to suffer from access site complications as those who need rescue PCI. Transradial approach has major additional advantages of decreasing the incidence of MACE compared to transfemoral approach. Transradial approach has another advantages of decreasing the in hospital stay.

Safety of Early Ambulation After Diagnostic and Therapeutic Neuroendovascular Procedures Without Use of Closure Devices

Neurosurgery ◽  
2010 ◽  
Vol 66 (3) ◽  
pp. 493-497 ◽  
Author(s):  
Anne Wagenbach ◽  
Andrea Saladino ◽  
Wilson P. Daugherty ◽  
Harry J. Cloft ◽  
David F. Kallmes ◽  
...  
Keyword(s):  
Diagnostic Procedures ◽  
Bed Rest ◽  
Therapeutic Procedure ◽  
Manual Compression ◽  
Access Site ◽  
Femoral Access ◽  
Early Ambulation ◽  
Surgical Evacuation ◽  
Therapeutic Procedures ◽  
Large Hematoma

Abstract OBJECTIVE To evaluate the safety of manual compression and early ambulation after diagnostic and therapeutic neuroendovascular procedures. METHODS Data were prospectively collected and retrospectively analyzed for consecutive patients undergoing diagnostic or therapeutic neuroendovascular procedures. Manual compression at the femoral access site was applied. The target for early ambulation was 2 hours after compression. RESULTS Three hundred forty-three patients were enrolled, of whom 295 were eligible for early ambulation. Diagnostic procedures totaled 214 (72.5%); therapeutic procedures, 81 (27.5%). Ambulation occurred at 2 hours for 82 patients who underwent a diagnostic and 11 patients who underwent a therapeutic procedure. Overall, 142 patients (66.4%) after a diagnostic and 21 patients (25.9%) after a therapeutic procedure ambulated within 3 hours; 94% of outpatients ambulated within 2 to 3 hours and were dismissed shortly thereafter. Delayed ambulation was related to nursing staff delays, recovery from general anesthesia, or patient preference. Fourteen patients (4.7%)—9 (4.2%) who had a diagnostic and 5 (6.2%) who had a therapeutic procedure—required delayed ambulation because of local oozing (8 patients), a hematoma of less than 5 cm (3 patients), a pseudoaneurysm (2 patients), or a large hematoma requiring surgical evacuation (1 patient). CONCLUSION Early ambulation is feasible and safe after diagnostic and therapeutic procedures and manual compression. A longer period of bed rest or the routine use of closure devices is often not required; thereby avoiding the costs associated with bed rest and the complications associated with closure devices.

scholarly journals Complication Rates of Percutaneous Brachial Artery Puncture: Effect of Live Ultrasound Guidance

2021 ◽  
Author(s):  
Konrad Appelt ◽  
Martin Takes ◽  
Christoph J Zech ◽  
Tilman Schubert
Keyword(s):  
Upper Extremity ◽  
Brachial Artery ◽  
Complication Rates ◽  
Puncture Site ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Us Guidance ◽  
Major Complications ◽  
The Impact

Abstract PurposeThe current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications.Materials and MethodsThis is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 hours, either achieved hemostasis.Results75 procedures in 71 patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (11/14.7%), upper extremity (36/48%), visceral (20/26.7%), and lower extremity (12/16%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred.ConclusionExclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.

Fast-track incorporation of the transradial approach in endovascular neurointervention

2019 ◽  
Vol 12 (2) ◽  
pp. 176-180 ◽  
Author(s):  
Eyad Almallouhi ◽  
Jonathan Leary ◽  
Jeffrey Wessell ◽  
Sami Al kasab ◽  
Suhas Pai ◽  
...  
Keyword(s):  
Interventional Procedures ◽  
Diagnostic Procedures ◽  
Early Experience ◽  
Outpatient Setting ◽  
Balloon Occlusion ◽  
Transradial Approach ◽  
Tumor Embolization ◽  
Balloon Occlusion Test ◽  
Transradial Access ◽  
Aneurysm Embolization

BackgroundThe transradial approach as a frontline approach is a novel technique in neuroendovascular procedures. In this study we aim to present our early experience with full transition to transradial access as the first-line approach for neuroendovascular procedures.MethodsWe prospectively collected data on the first 100 consecutive patients who underwent a diagnostic or interventional neuroendovascular procedure using the transradial approach at our institution between March 22 and April 30, 2019. Baseline characteristics were collected in addition to the type of procedure, access site, catheters and wires used, complications, and whether there was crossover to transfemoral access.ResultsTransradial access was attempted in 121 cases and 91 cases were completed successfully (72 diagnostic procedures and 19 interventional procedures). Mean (SD) age was 56.8 (14.7) years, 54.9% (50/91) underwent the procedure in the outpatient setting, and 60.4% (55/91) were women. Seven patients had minor immediate complications related to the radial access. Interventional procedures successfully performed included aneurysm embolization (ruptured (n=3) and unruptured (n=8)), tumor embolization (n=2), cervical internal carotid artery stenting (n=2), balloon occlusion test (n=1), vertebral artery sacrifice (n=1), and arteriovenous malformation embolization (n=2).ConclusionIn this early experience, full transition to the transradial approach as the frontline approach is feasible with a low complication rate for both diagnostic and interventional neuroendovascular procedures.

scholarly journals Complication rates of percutaneous brachial artery puncture: effect of live ultrasound guidance

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
K. Appelt ◽  
M. Takes ◽  
C. J. Zech ◽  
KA Blackham ◽  
T. Schubert
Keyword(s):  
Upper Extremity ◽  
Brachial Artery ◽  
Complication Rates ◽  
Puncture Site ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Us Guidance ◽  
Major Complications ◽  
The Impact

Abstract Purpose The current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications. Materials and methods This is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis. Results Seventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred. Conclusion Exclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.

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