Radial Artery Access Reliable Approach for Neurointervention with Minimal Complications

A recent study undertaken by researchers at PGI Chandigarh aimed to assess the safety and feasibility of the radial access for therapeutic neurointervention procedures. The findings reveal great potential in replacing the transfemoral route with minimal complications.

For decades, the transfemoral approach (TFA) has been the standard for diagnostic and therapeutic neurointervention due to its larger diameter, greater familiarity, easy accessibility, and relatively straight angle for catheterization of aortic arch vessels.

The transradial approach (TRA), now considered the standard in cardiology literature, demonstrates advantages such as a superficial vessel location, fewer access site complications, shorter hospital stay, and better patient acceptance. Recent literature supports the safety and feasibility of TRA for therapeutic neurointervention procedures. However, challenges include the small caliber of the radial artery, a learning curve for new operators, and a lack of dedicated radial-specific hardware, posing difficulties in assessing aortic arch vessels in some instances.

The retrospective evaluation, published in the Indian Journal of Neurosurgery, included 20 patients who underwent therapeutic neurointervention through transradial access from July 2021 to April 2022. The study aimed to showcase early institutional experience with TRA for therapeutic neurointervention cases, achieving technical success in 18 cases (90%). Conversion to TFA was required in two cases (10%), managed with a Ballast sheath. No immediate access site complications were observed.

Follow-up ultrasound at one month in 10 patients revealed no evidence of radial artery occlusion. One patient developed a small pseudoaneurysm, managed with compression using a radial band for 4 hours. The authors highlight the high safety, efficacy, and feasibility of radial access for therapeutic neurointerventions based on these results.

Two cases (10%) were performed via the left radial approach, facing challenges such as increased distance and difficult catheterization of the left common carotid artery. This approach was reserved for specific cases.

The authors acknowledge initial challenges when shifting to transradial from the well-established TFA, emphasizing the importance of familiarity with radial puncture and aortic arch morphology. They suggest performing 40 to 50 diagnostic radial cerebral angiograms before therapeutic cases. Despite challenges, the authors conclude that the radial artery offers advantages like fewer chances of puncture site hematoma, early discharge, and patient mobilization, recommending careful case selection during the initial phase of transitioning from TFA to TRA.

Reference:

Bhatia, Vikas & Kumar, Ajay & Wani, Mohd & Singla, Navneet & Prabhakar, Anuj & Karthigeyan, Madhivanan & Chauhan, Rajeev. (2022). Therapeutic Neurointervention through Transradial Approach: Preliminary Experience from a Tertiary Care Center. Indian Journal of Neurosurgery. 12. 10.1055/s-0042-1758778.