Exploring the Transradial Approach in Neurointervention

Transradial access (TRA) is gradually getting attention in neurointervention radiology, suggests a recent review article published in the Journal of Neurosciences in Rural Practice (Scientific Scholar). The review adds that neurointerventionists now understand its advantages such as lesser complications, short hospital stays, and better patient satisfaction than transfemoral access. The article by researchers from PGIMER, Chandigarh aimed to delineate a step-by-step approach for the interventionist to better understand the radial access route to perform neurointervention.

Radial artery diameter, as well as the patient’s age, is significant determinant in patient selection. The researchers recommend that the lower limit of the radial artery diameter be at least 1.8 mm to accommodate a 5F sheath. The arm is preferably positioned at an angle of 0–15° to the side of the patient, and this positioning matches that of the patient’s groin use in transfemoral access.

Puncture is done at 2–3 cm proximal to the radial styloid process by keeping the puncture needle at 25-40°to the forearm under ultrasound guidance. The puncture needle is advanced until the blood is seen in the hub of the puncture needle. At this point, the inner stylet is removed and gentle withdrawal is made until arterial backflow is observed. The 0.018” wire is gently advanced avoiding any resistance. The outer Cannula is removed keeping the wire in place.5F sheath with dilator is gently passed over the wire into the radial artery. A small nick may be required at the skin site, a complete sheath is inserted into the radial artery and the dilator is removed.

Backflow through the sheath is checked, and any air bubbles are removed. Slow injection of the radial cocktail is given at the rate of 0.5-1 ml/sec after diluting with the blood. A Tegaderm is applied to secure the sheath to avoid repeated movements at the puncture site, which may cause spasms. Their usual practice is taking a radial artery angiogram after sheath insertion to visualize any anatomical variations, loops, or spasms before catheter insertion.

Reference: Bhatia V, Kumar A, Arafath MY. Transradial approach in neurointervention: Part-1: Patient selection, preparation, and access site considerations. J Neurosci Rural Pract 2023;14:7-15