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Abstract WMP2: Pearls and Pitfalls of the Transradial Approach for Neurointerventions: Lessons Learned After 570 Cases


 Background and Purpose:
 Trans radial catheterization is an alternate route of access that has started to gain more widespread use for neuroendovascular procedures. There are several randomized controlled trials from cardiac field that had established its safety and efficacy. We present our institution’s experience in performing neuroendovascular interventions via a transradial approach.
 
 
 Methods:
 We conducted a retrospective analysis and identified 570 patients who underwent consecutive neuroendovascular interventions via radial artery access. Data collection was performed on indication for procedure, sheath size, catheter type, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, conversion to femoral approach, access site complication, and procedure success.
 
 
 Results:
 Of 570 patients with an average age of 59.4 years ± 14.7, 406 (71.2%) underwent diagnostic angiograms and 164 (28.7%) underwent therapeutic procedures. The overall mean number of vessels catheterized was 2.9 ± 1.7 per procedure. The RCCA was the most frequent selectively catheterized artery; 340 (22.9%), followed by LCCA; 306 (20.6%), RICA; 250 (16.8%), LICA; 238 (16.0%), RVA; 159 (10.71%), LVA; 76 (5.1%), RECA; 61 (4.1%), and lastly the LECA selectively catheterized in 54 (3.6%). The average amount of contrast given was 83.4 cc ± 51.Successfully completed therapeutic procedures included aneurysm simple coiling (34 patients), stent assisted coiling (30 patients), flow diversion (34) patients), ICA balloon angioplasty and stenting (20 patients), Web device (8), AVM embolization (14), IAC for retinoblastoma (1 patient), and stroke thrombectomy (23 patients). The average duration was 72 mins ± 43, and average fluoroscopy time was 13.20 mins ± 11.20. Seventeen patients (3.2%) required conversion to transfemoral access. Twelve minor complications (2.3%) were reported including mild oozing after deflation of the balloon, ecchymosis, mild swelling. No major complications were encountered.
 
 
 Conclusions:
 Radial artery catheterization is a safe and effective access site to perform a wide range of diagnostic and therapeutic procedures. Complication and conversion rate are low making it a safe alternative.
