Transradial access for neurointerventions: management of access challenges and complications

BackgroundNumerous large randomized trials have shown a significant morbidity and mortality benefit with the transradial approach (TRA) over the transfemoral approach (TFA) for endovascular procedures. However, this technique is routinely avoided or aborted due to unfamiliarity with the technique and the associated anatomical difficulties that may be faced in this approach. The objective of this review is to identify both the common and uncommon challenges that may be encountered during a transradial approach for cerebrovascular catheterization and to provide tips and tricks to overcome the transradial learning curve.MethodA careful review of the literature and of all our transradial cases was carried out to identify the common challenges and complications that are encountered when using TRA for diagnostic cerebral angiography and neurointerventions.ResultsA stepwise approach is provided to prevent and manage common challenges including radial artery access failure, radial artery spasm, radial artery anomalies and tortuosity, radial artery occlusion, radial artery perforation and hematoma, subclavian tortuosity and anomalies, and catheter knots and kinks.ConclusionThe ability to recognize and navigate anatomical variations and complications unique to TRA will accelerate learning, decrease unnecessary morbidity and mortality, and further advance the neurovascular field.

Urethral Catheter Knots

Balloon bladder catheters smaller than 8F are available in the United States on a limited basis; therefore, 3F and 5F feeding tubes are commonly used as bladder catheters in neonates and small infants. Knotting of these catheters in the bladder lumen has been reported in the urobogic1-4 but not the pediatric literature. It has been suggested that knots occur when improper technique is used to insert and secure feeding tubes used to drain the bladder3. Because pediatricians and pediatric nurses commonly use feeding tubes as bladder catheters, they should be aware that knotting is a possible complication. We present an infant in whom a 5F feeding tube knotted in the bladder.