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.

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.

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.

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.

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.

Cutaneous analgesia before transradial access for coronary intervention to prevent radial artery spasm

Perfusion ◽  
2017 ◽  
Vol 33 (2) ◽  
pp. 110-114 ◽  
Author(s):  
Ersan Tatlı ◽  
Mustafa Adem Yılmaztepe ◽  
Mustafa Gökhan Vural ◽  
Alptuğ Tokatlı ◽  
Murat Aksoy ◽  
...  
Keyword(s):  
Treatment Group ◽  
Radial Artery ◽  
Substantial Reduction ◽  
Coronary Intervention ◽  
Control Group ◽  
Access Site ◽  
Patient Discomfort ◽  
Vas Score ◽  
Coronary Interventions ◽  
Transradial Access

Aim: Transradial access (TRA) for coronary intervention is increasingly used in current clinical practice. The aim of the present study was to evaluate the hypothesis that cutaneous analgesia before TRA for coronary intervention at a puncture site 30 minutes before puncture can reduce patient discomfort and the incidence of radial artery spasm (RAS). Methods: Patients (n=104) undergoing planned coronary interventions using TRA were prospectively randomized to receive either 1 mL of 1% lidocaine subcutaneously (n=52) (control group) or subcutaneous lidocaine plus 5% lidocaine cream (n=52) cutaneously 30 minutes before puncture (treatment group). The primary endpoint was angiographically or clinically confirmed RAS. Secondary endpoints were the occurrence of patient discomfort in the forearm during the procedure and access-site crossover to the femoral artery. Patient discomfort was quantified with a visual analogue scale (VAS) score. Results: Fifty-two patients in the treatment group (60.5±9.4 years of age and 16 female) and 52 patients in the control group (60.4±9.7 years of age and 16 female) were included in the final analysis. Radial artery spasm occurrence decreased in the treatment group compared to the control group (26.9% vs 9.6%; p=0.04) accompanied by a VAS score of 3.7±1.8 in the treatment group and 4.9±2.0 in the control group; p=0.02. The access site crossover rate did not differ between the groups (7.6% vs 21.1%; p=0.09). Conclusion: Cutaneous analgesia before TRA for coronary interventions is associated with a substantial reduction in the RAS and the procedure-related level of patient discomfort.

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.

Abstract 15522: Multiple Brachial ‘Tornado’ Loops Encountered During Transradial Access - A Case Report With Review of Literature

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aditi S Vaishnav ◽  
Avani Vaishnav ◽  
Shankar Iyer ◽  
Sudhir Vaishnav
Keyword(s):  
Case Report ◽  
Severe Pain ◽  
Stress Test ◽  
Lv Function ◽  
Anatomic Variations ◽  
Review Of Literature ◽  
Access Site ◽  
Femoral Access ◽  
Transradial Access ◽  
Guiding Catheter

Introduction: Although transradial access (TRA) is widely accepted for cardiac catheterization, technical difficulties may occur due to variations in the radial-brachial-subclavian artery anatomy. Clinical Vignette: A 70-year old man presented with typical angina, positive stress test and normal LV function. Elective coronary angiography via TRA was planned since there were no contraindications. A guidewire was inserted and advanced via right radial puncture. Due to resistance above the elbow, the wire was withdrawn and check shoots were taken. These revealed a brachial loop, which was crossed and straightened with a Teflon coated angioplasty wire (0.014BMW wire). On advancing further, resistance was encountered again. Check-shoots at this point revealed multiple tortuous tornado-like brachial loops. Attempts to cross these using a BMW wire and 4F-RCA guiding catheter were unsuccessful as the artery went into spasm, preventing further manipulation. Ipsilateral TRA was abandoned due to risk of arterial perforation and severe pain; contralateral TRA was not attempted due to patient’s refusal. The procedure was completed via femoral access. Discussion: To the best of our knowledge, this is the first report of multiple brachial loops, which highlights certain unique challenges- 1. Complex anatomic variations can occur exclusive of signs used to assess TRA amenability 2. No guidelines on procedural techniques 3. No data to guide the alternative access site as it is unknown whether brachial loops tend to occur bilaterally, unlike radial loops 4. Unlike radial and subclavian arteries, there are no data on association of demographic factors with brachial artery variations. Conclusion: Anatomic variations of upper limb arteries, although rare, can cause technical difficulties and TRA failure. If resistance is encountered, an angiogram should be performed through the sheath to assess anatomy, to prevent severe spasm and perforation from forceful catheter advancement.

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