Safety and feasibility of ulnar artery access for neuroangiography and neurointervention: a case series

2020 ◽  
pp. neurintsurg-2020-016416
Author(s):  
Rimal H Dossani ◽  
Muhammad Waqas ◽  
Michael K Tso ◽  
Gary B Rajah ◽  
Daniel Popoola ◽  
...  
Keyword(s):  
Radial Artery ◽  
Descriptive Analysis ◽  
Case Series ◽  
Ulnar Artery ◽  
Middle Meningeal Artery ◽  
Artery Occlusion ◽  
Femoral Access ◽  
Radial Access ◽  
Diagnostic Angiography ◽  
Neurointerventional Procedures

BackgroundRadial access has become popular among neurointerventionalists because it has favorable risk profiles compared with femoral access. Difficulties in accessing or navigating the radial artery have been viewed as a reason to convert to femoral access, but ulnar artery access may prevent complications associated with transfemoral procedures.ObjectiveTo evaluate the safety and feasibility of ulnar access for neurointerventions and diagnostic neuroangiographic procedures.MethodsConsecutive patients who underwent diagnostic angiography or neurointerventional procedures via ulnar access between July 1, 2019 and April 15, 2020 were included. Data recorded were demographics, procedure indication, devices, technique, and complications. Descriptive analysis was performed.ResultsUlnar artery access was obtained for 21 procedures in 18 patients (mean age 70.3±7.8 years; nine men). Procedures included 13 diagnostic angiograms and eight neurointerventions (3 left middle meningeal artery embolization, 1 of which was aborted; 2 carotid artery stenting; 2 angioplasty; 1 mechanical thrombectomy for in-stent thrombosis). A right-sided approach with ultrasound guidance was used for all cases except one. Indications included small caliber radial artery (n=9), radial artery occlusion (n=10), and radial artery preservation for potential bypass (n=2). A 5-French slender sheath was used for diagnostic angiography; a 6-French slender sheath was used for neurointerventions. No case required conversion to femoral access. Two patients had minor hematomas after the procedure; one other had ulnar artery occlusion on 30-day ultrasonography.ConclusionUlnar access is safe and feasible for diagnostic and interventional neuroangiographic procedures. It provides a useful alternative to radial access, potentially avoiding complications associated with femoral access.

P6523Radial artery occlusion: predictors, methods for reducing the frequency of complications-a single center study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Ognerubov ◽  
A Tereshchenko ◽  
E Merkulov ◽  
S Provatorov ◽  
G Arutyunyan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Angiography ◽  
Radial Artery ◽  
Stable Coronary Artery Disease ◽  
Ulnar Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Careful Examination ◽  
Radial Access ◽  
Short Time

Abstract Radial access has great advantages in terms of the frequency of complications, but it has one specific complication - radial artery occlusion (RAO). This complication often does not manifest itself in any way; however, it limits the use of access for the future interventions. Aim To compare methods of short and traditional hemostasis and to identify the main predictors of RAO after radial access. Materials and methods During the period from 2012 to 2018, 2000 patients were included in the study, which consisted of two parts: prospective - 1000 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) with stable coronary artery disease, and retrospective part of the study, which included 1000 patients admitted for PCI from other clinics. In a prospective study, patients were divided into two groups: after coronary angiography and PCI, respectively (n=500 in the coronary angiography group and n=500 in the PCI group), and then randomized. Hemostatic bandages in the first group of patients (n=250) were removed after 12–24 hours, in the second group (n=250) - after 4±1 hours. When the occlusion of the radial artery was detected, all patients underwent an hour-long compression of the ipsilateral ulnar artery to recanalize acute RAO. Results The frequency of RAO in the retrospective part of the study was 21.8%. The frequency of RAO in the prospective part of the study was 10.2% with a traditional time hemostasis and 1.4% with a short-time compression (P<0.001). Predictors of the RAO are illustrated in table 1. Predictors of bleeding were PCI (OR 0.12, 95% CI 0.01–0.67, P=0.05) and weight (OR 1.09, 95% CI 1.02–1.18, P=0.01). Table 1. Predictors of RAO Variables Odds ratio 95% Confidential interval Significance, P Traditional-time hemostasis 8.78 4.2–21.5 <0.001 Diabetes mellitus+smoking 18.1 12.7–26.7 <0.001 Diabetes mellitus 0.45 0.25–0.83 0.009 Body mass index 0.95 0.91–0.99 0.02 Male 1.75 1.01–3.18 0.05 Protein C 0,86 0,75–0,96 0,01 Conclusion Careful examination of the patient for detecting RAO before and after interventions is essential. Short hemostasis with compression of the ipsilateral ulnar artery reduce the frequency of RAO. For short-time hemostasis, special attention should be paid to patients after PCI and with low BMI, as far as these factors are associated with a greater risk of bleeding after removal of the compression bandage.

Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study

2020 ◽  
Vol 12 (8) ◽  
pp. 798-801 ◽  
Author(s):  
Anna Luisa Kühn ◽  
Katyucia de Macedo Rodrigues ◽  
Jasmeet Singh ◽  
Francesco Massari ◽  
Ajit S Puri
Keyword(s):  
Radial Artery ◽  
Central Retinal Artery Occlusion ◽  
Clinical Information ◽  
Retinal Artery Occlusion ◽  
Middle Meningeal Artery ◽  
Artery Occlusion ◽  
Femoral Access ◽  
Endovascular Interventions ◽  
Device Placement ◽  
Woven Endobridge

PurposeTo report the first use of distal radial artery (dRA) access for a variety of neurointerventions and to demonstrate the safety and feasibility of this approach.MethodsA retrospective review of our prospective neurointerventional database of endovascular interventions was conducted and, between May and October 2019, all patients in whom the intervention was performed via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data were collected.Results48 patients with a mean age of 64.4 years (range 35–84 years) were included. 27 patients were female. dRA access was achieved in all cases. Conversion to femoral access was required in five cases (10.4%) due to tortuous vessel anatomy and limited support of the catheters in the aortic arch. Interventions performed included aneurysm treatment (with flow diverters, Woven EndoBridge device placement, coiling or stent-assisted coiling), arteriovenous malformation and dural arteriovenous fistula embolization, carotid artery stentings, stroke thrombectomy, thrombolysis for central retinal artery occlusion, intracranial stenting, middle meningeal artery embolization, vasospasm treatment, and spinal angiography with embolization. Radial artery vasospasm was seen in two cases and successfully treated with antispasmolytic medication. No symptomatic radial artery occlusion or ischemic event was observed.ConclusiondRA access is safe and effective for a variety of neurointerventions. Our preliminary experience with this approach is very promising and shows high patient satisfaction.

scholarly journals Radial Artery Access

2020 ◽  
Author(s):  
Carmelo Panetta ◽  
Johnny Chahine
Keyword(s):  
Clinical Research ◽  
Radiation Exposure ◽  
Radial Artery ◽  
Ulnar Artery ◽  
The Elderly ◽  
Artery Occlusion ◽  
New Techniques ◽  
Radial Approach ◽  
Radial Access ◽  
Radial Artery Occlusion

Radial artery access for angiography has matured over the past two decades and is now the preferred point of access for most patients. Lower bleeding rates in clinical randomized trials have translated into lower mortality prompting change in the guidelines. Advances in technique with use of ultrasound for access to properly size the sheath, proper dosing of anticoagulation and new techniques for sheath removal have dramatically lowered radial artery occlusion rates. Radial artery spasm has improved with vasodilators and proper sedation. Advances in support boards and sheath extension have opened up left radial access. Advances in lower profile sheaths and sheathless systems allow larger catheters in smaller arteries. Advances in longer balloons and sheaths have opened up radial access for peripheral interventions. Areas of clinical research include use of ulnar artery compared to radial, left versus right radial access, use of radial artery for a surgical conduit after angiography, radiation exposure and advantage of radial approach in the elderly.

Feasibility of repeat transradial access for neuroendovascular procedures

2019 ◽  
Vol 12 (4) ◽  
pp. 431-434 ◽  
Author(s):  
Stephanie H Chen ◽  
Marie-Christine Brunet ◽  
Samir Sur ◽  
Dileep R Yavagal ◽  
Robert M Starke ◽  
...  
Keyword(s):  
Radial Artery ◽  
Artery Occlusion ◽  
Access Site ◽  
Transfemoral Approach ◽  
Radial Access ◽  
Artery Segment ◽  
Clinical Consequences ◽  
Radial Artery Occlusion ◽  
Neurointerventional Procedures ◽  
Repeat Procedures

IntroductionTransradial artery access (TRA) for cerebrovascular angiography is increasing due to decreased access site complications and overwhelming patient preference. While interventional cardiologists have reported up to 10 successive TRA procedures via the same radial access site, this is the first study examining successive use of the same artery for repeat procedures in neurointerventional procedures.1 MethodsWe reviewed our prospective institutional database for all patients who underwent a transradial neurointerventional procedure between 2015 and 2019. Index procedures were defined as procedures performed via TRA after which there was a second TRA procedure attempted. Reasons for conversion to a transfemoral approach (TFA) for subsequent procedures were identified.Results104 patients underwent 237 procedures (230 TRA, 7 TFA). 97 patients underwent ≥2 TRA procedures, 20 patients >3, four patients >4, three patients >5, and two patients >6 TRA procedures. The success rate was 94.7% (126/133) with 52% (66/126) of successive procedures performed via the same radial access site (snuffbox vs antebrachial) while the alternate radial artery segment was used for access in 48% (60/126) of subsequent procedures. There were seven (5.3%) cases requiring crossover to TFA, six cases for radial artery occlusion (RAO) and one for radial artery narrowing.ConclusionSuccessive TRA is both technically feasible and safe for neuroendovascular procedures in up to six procedures. The low failure rate (5.3%) was primarily due to RAO. Thus, even without clinical consequences, strategies to minimize RAO should be optimized for patients to continue to benefit from TRA in future procedures.

scholarly journals Ulnar Artery Access: A Nontraditional Access Site for Diagnostic Cerebral Angiography and Neurointervention: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Rimal H Dossani ◽  
Muhammad Waqas ◽  
Justin M Cappuzzo ◽  
Ashish Sonig ◽  
Faisal Almayman ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Video Recording ◽  
Ulnar Artery ◽  
Lateral Approach ◽  
Access Site ◽  
Transfemoral Approach ◽  
Radial Access ◽  
Institutional Review ◽  
Neurointerventional Procedures

Abstract Transfemoral access has long been the main access site for cerebral angiography and neurointerventional procedures. Radial access is accepted as an alternative to the traditional transfemoral approach. Ulnar access may be undertaken if the radial artery is occluded or small caliber, or when radial artery preservation is needed. The safety and feasibility of ulnar access for neuroangiographic procedures has been demonstrated.1-3 In this operative video, we demonstrate ulnar artery access in a patient in whom radial artery preservation was desired. We further elaborate on the technical nuances of this access. This nontraditional access site offers the same advantages as radial access, avoiding the need to switch to femoral artery access. A preoperative Allen's test is not necessary. Ultrasound imaging is used to aid in the identification and successful puncture of the ulnar artery. A medial to lateral approach for ulnar artery puncture is advised to avoid injury to the ulnar nerve. Careful application of wrist closure bands avoids hematoma accumulation.  The patient gave informed consent for the procedure and video recording. Institutional review board approval was deemed unnecessary.  Video. © University at Buffalo, May 2021. Used with permission.

scholarly journals Ultrasound-guided trans-occluded radial access for a patient with pre-existing radial artery occlusion undergoing endovascular therapy: A case report

2021 ◽  
pp. 100015
Author(s):  
Toshihiko Kishida ◽  
Shinsuke Mori ◽  
Masahiro Yamawaki ◽  
Norihiro Kobayashi ◽  
Masakazu Tsutsumi ◽  
...  
Keyword(s):  
Case Report ◽  
Radial Artery ◽  
Endovascular Therapy ◽  
Artery Occlusion ◽  
Ultrasound Guided ◽  
Radial Access ◽  
Radial Artery Occlusion

scholarly journals Radial access for cerebrovascular procedures: Case report and technical note

2015 ◽  
Vol 22 (2) ◽  
pp. 227-235 ◽  
Author(s):  
Sudhakar R Satti ◽  
Ansar Z Vance ◽  
Thinesh Sivapatham
Keyword(s):  
Standard Of Care ◽  
Technical Note ◽  
Myocardial Infarctions ◽  
Cerebral Vasculature ◽  
Femoral Access ◽  
Simplified Approach ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
Available Technology ◽  
Neurointerventional Procedures

Background Advantages of radial access over brachial/axillary or femoral access have been well described for several decades and include decreased cost, patient preference, and decreased major access site complications. Despite these advantages, radial access is rarely employed or even considered for neurointerventional procedures. This attitude should be reconsidered given several recent large, randomized, controlled trials from the cardiovascular literature proving that radial access is associated with statistically lower costs, decreased incidence of myocardial infarctions, strokes, and even decreased mortality. Radial access is now considered the standard of care for percutaneous coronary interventions in most US centers. Although radial access has been described for neurovascular procedures in the past, overall experience is limited. The two major challenges are the unique anatomy required to access the cerebral vasculature given very acute angles between the arm and craniocervical vessels and limitations in available technology. Methods We present a simplified approach to radial access for cerebrovascular procedures and provide a concise step-by-step approach for patient selection, ultrasound-guided single-wall access, recommended catheters/wires, and review of patent hemostasis. Additionally, we present a complex cerebrovascular intervention in which standard femoral access was unsuccessful, while radial access was quickly achieved to highlight the importance of familiarity with the radial approach for all neurointerventionalists. Results We have found that the learning curve is not too steep and that the radial access approach can be adopted smoothly for a large percentage of diagnostic and interventional neuroradiologic procedures. Conclusions Radial access should be considered in all patients undergoing a cerebrovascular procedure.

Abstract 374: Trans-radial Access Angiography Learning Curve

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Julian Chan ◽  
Rosanna Tavella ◽  
John F Beltrame ◽  
Matthew Worthley ◽  
Sivabaskari Pasupathy ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Learning Curve ◽  
Radial Artery ◽  
Vascular Access ◽  
Best Practice ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Increased Risk ◽  
Radial Operators

Introduction: Radial artery access has been adopted widely around the world as standard best practice for coronary angiography with or without percutaneous coronary intervention. Radial artery access offers benefits in regard to reduced major bleeding, reduced hospital stay, fewer vascular complications, similar procedural times, patient preference and a mortality benefit in acute coronary syndrome/STEMI management. Despite transradial access being best practice, there has been a slow uptake of this technique amongst some cardiologists/interventionalists, particularly in the USA. This may partially be attributed to uncertainties regarding the learning curve and concerns regarding delaying treatment in STEMI if radial access fails. Methods: Using the data from the Coronary Angiography Database Of South Australia registry (CADOSA), we sought to determine the radial access failure rates for acute cases during transition from routine femoral access to routine radial access from 2012 to 2016, a period when the greatest transition in practice occurred. Data regarding initial vascular access, success or failure, and subsequent vascular access was prospectively recorded for all cases. Operators with at least a 70% rate of initial radial access were deemed to be established radial operators and acted as controls for operators transitioning from femoral access (at least 70% of cases) to radial access during the study period. Cases were further classified as elective, urgent (eg inpatient ACS) or emergency (eg STEMI). Results: There were 23 operators with sufficient volumes, responsible for 20,073 cath lab visits during the 5 year period studied. The overall radial access rate increased from 57% in 2012 to 78% in 2016. For operators transitioning from a default femoral access (76% of case) to a default radial access (75% of cases), the radial access failure rate for urgent and emergency cases was 3.7%, compared to 3.5% for experienced radial operators over the same period. Conclusion: Despite strong evidence of benefit for radial access angiography and intervention, compared to femoral access, some operators remain reluctant to transition. Utilising the CADOSA database, we observed a safe transition from femoral to radial access without an increased risk of access site failure for acute cases. Transition from femoral to radial access can be made safely by a range of clinicians managing acute cases.

Transradial middle meningeal artery embolization for chronic subdural hematoma using Onyx: case series

2020 ◽  
pp. neurintsurg-2020-016185
Author(s):  
Gary B Rajah ◽  
Muhammad Waqas ◽  
Rimal H Dossani ◽  
Kunal Vakharia ◽  
Andrew D Gong ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Conscious Sedation ◽  
Case Series ◽  
Chronic Subdural Hematoma ◽  
Antiplatelet Agents ◽  
Middle Meningeal Artery ◽  
Complication Rates ◽  
Femoral Access ◽  
Guide Catheter ◽  
Meningeal Artery

BackgroundMiddle meningeal artery (MMA) embolization is an emerging therapy for the resolution of subacute or chronic subdural hematoma (CSDH). CSDH patients are often elderly and have several comorbidities. We evaluated our experience with transradial access (TRA) for MMA embolization using predominantly Onyx under conscious sedation.MethodsData for consecutive patients who underwent transradial MMA embolization for CSDH during a 2-year period (2018–2019) were analyzed from a single-center, prospectively-maintained database. Patient demographics, comorbidities, ambulatory times, subdural hematoma resorption status, and guide catheter type were recorded. Conversion to femoral access and complication rates were also recorded. Univariate and multivariate analyses were performed.ResultsForty-six patients (mean age, 71.7±14.4 years) were included in this study. Mean CSDH size was 14±5.5 mm. Most (91.3%) TRA embolizations were performed with 6-French 0.071-inch Benchmark guide catheters (Penumbra). MMA embolization was successful in 44 patients (95.7%) (including two cases of TRA conversion). Twenty-one (48%) patients had a severe Charlson Comorbidity Index (>5). Symptomatic improvement was noted in 39 of 44 patients (88.6%). Mean length of stay was 4±3 days. Patients were ambulated immediately postprocedure. At mean follow-up (8±4 weeks), 86.4% of patients had complete or partial CSDH resolution. Persistent use of antiplatelet agents after the procedure was associated with failed or minimal CSDH resorption (5 of 6, 83.3% vs 9 of 38 23.7% with complete or near-complete resolution; P=0.009).ConclusionTransradial Onyx MMA embolization under conscious sedation is safe and effective for CSDH treatment. TRA may be especially useful in elderly patients with numerous comorbidities.

scholarly journals Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention

2019 ◽  
Vol 12 (22) ◽  
pp. 2235-2246 ◽  
Author(s):  
Ivo Bernat ◽  
Adel Aminian ◽  
Samir Pancholy ◽  
Mamas Mamas ◽  
Mario Gaudino ◽  
...  
Keyword(s):  
Best Practices ◽  
Radial Artery ◽  
Artery Occlusion ◽  
Diagnostic Angiography ◽  
Radial Artery Occlusion
Sign in / Sign up

Export Citation Format

Share Document