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Chen T, Li L, Yang A, Fan X, Shi G, Li F, Cai G. The important role of preoperative ultrasound in the efficacy and safety of coronary intervention via distal transradial access. BMC Cardiovasc Disord 2025; 25:404. [PMID: 40419945 PMCID: PMC12105204 DOI: 10.1186/s12872-025-04861-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 05/14/2025] [Indexed: 05/28/2025] Open
Abstract
BACKGROUND The optimal inner diameter for enhancing the success rate of distal radial artery (DRA) puncture has not been documented. The aim of this study was to explore the appropriate inner diameter of DRA to increase the success rate of puncture and reduce vascular complications. METHODS This is a retrospective study. A receiver operating characteristic (ROC) curve was plotted to predict the DRA inner diameter for puncture success. The operative efficacy and safety were compared between groups with different DRA inner diameters, grouped according to the cut-off value. RESULTS A total of 670 patients were included in the study. The DRA inner diameter had a significant predictive value (AUC = 0.718) for puncture success, with a cut-off value of 1.95 mm. The puncture success rate was significantly lower in the DRA inner diameter < 2.0 mm group than in the DRA inner diameter ≥ 2.0 mm group (93.1% vs. 98.2%, P = 0.001). Twenty-five (3.7%) developed distal radial artery occlusion (dRAO) after the operation, including 15 dRAO without proximal radial artery occlusion (pRAO) and 10 dRAO with pRAO. The incidence of dRAO with pRAO was significantly greater in the DRA inner diameter < 2.0 mm subgroup than in the DRA inner diameter ≥ 2.0 mm subgroup (2.8% vs. 0.5%, P = 0.041). CONCLUSIONS The success rate of puncture was lower in patients with DRA inner diameter < 2.0 mm, whereas the incidence of dRAO with pRAO was higher. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Tao Chen
- Department of Cardiology, The First Affiliated Hospital Of Ningbo University, Ningbo City, 315000, Zhejiang Province, China
| | - Lamei Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, 213017, Jiangsu Province, China
| | - Anni Yang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, 213017, Jiangsu Province, China
| | - Xinyu Fan
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, 213017, Jiangsu Province, China
| | - Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, 213017, Jiangsu Province, China
| | - Feng Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, 213017, Jiangsu Province, China
| | - Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, 213017, Jiangsu Province, China.
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. A narrative review of history, advantages, future developments of the distal radial access. J Vasc Access 2024; 25:745-752. [PMID: 36262018 DOI: 10.1177/11297298221129416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article presents a historical excursus and a review of modern literature on distal radial access for interventional surgery, discussing the anatomical and physiological substantiation of the use of this access point in endovascular surgery, its advantages and disadvantages. The main considerations directly related to distal puncture, choice of instrumentation, hemostasis, possible complications, and prevention are analyzed. The major areas of interventional surgery (coronary, vascular, oncological, and neurointerventional), where the distal radial approach is actively used, are reflected and their characteristics are highlighted. In general, it has been shown that with the development of technology, improved manual skills, the widespread use of hydrophilic introducers, and modern sheathless guiding catheters, the vessel diameter, and puncture site are not decisive factors when choosing access for any type of intervention.
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Chen T, Li L, Yang A, Huang H, Shi G, Li F, Li W, Lu W, Xu L, Li L, Cai G. Incidence of Distal Radial Artery Occlusion and its Influencing Factors After Cardiovascular Intervention Via the Distal Transradial Access. J Endovasc Ther 2023:15266028231208638. [PMID: 37906607 DOI: 10.1177/15266028231208638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
INTRODUCTION One of the important advantages of the distal transradial access (dTRA) is the significant reduction in the incidence of radial artery occlusion (RAO). There are few reports on the influencing factors for distal radial artery occlusion (dRAO) after cardiovascular interventions via the dTRA. METHODS This retrospective analysis included the clinical data of patients who underwent a cardiovascular intervention via the dTRA. The dRAO was evaluated by ultrasound within 24 hours after the procedure. Multivariate logistic analysis was used to explore the influencing factors for dRAO. RESULTS The incidence of dRAO was 3.5% (28/805) at 24 hours follow-up after the procedure. In the comparison between the 2 groups, the preoperative distal radial artery (DRA) internal diameter in the dRAO group was significantly smaller than that in the non-dRAO group (p=0.001). The prevalence of DRA inner diameter/sheath outer diameter <1 was significantly higher in the dRAO group than in the non-dRAO group (p=0.013). The number of puncture attempts was significantly greater in the dRAO group than in the non-dRAO group (p=0.007). Multivariate logistic analysis showed that DRA inner diameter/sheath outer diameter <1 was an independent risk factor for dRAO (OR=4.827, 95% CI=1.087-21.441, p=0.039). CONCLUSIONS The incidence of dRAO 24 hours after cardiovascular intervention via the dTRA was 3.5%, and a DRA inner diameter/sheath outer diameter <1 was an independent risk factor for dRAO. Preoperative ultrasound assessment of vessel inner diameter and selection of a sheath with a smaller outer diameter may reduce the risk of dRAO. CLINICAL IMPACT The incidence of distal radial artery occlusion after cardiovascular intervention was 3.5%. The distal radial artery inner diameter/sheath outer diameter <1 was an independent risk factor for distal radial artery occlusion. Preoperative ultrasound assessment of vessel inner diameter and selection of a sheath with a smaller outer diameter may reduce the risk of distal radial artery occlusion. The number of puncture attempts and compression time were not related to distal radial artery occlusion.
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Affiliation(s)
- Tao Chen
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
| | - Lamei Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
| | - Anni Yang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
| | - Hui Huang
- Department of Cardiology, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin City, China
| | - Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
| | - Feng Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
| | - Wenhua Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
| | - Wei Lu
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
| | - Lingxia Xu
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
| | - Li Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
| | - Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, China
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Chivot C, Bouzerar R, Yzet T. A novel technique to perform cerebral angiography via the left radial approach: An 80 patients series. J Neuroradiol 2023; 50:93-98. [PMID: 33450347 DOI: 10.1016/j.neurad.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To demonstrate that left radial access for diagnostic cerebral angiography with Extra backup and 4F vertebral catheters is feasible and safe. MATERIALS AND METHODS This study is a retrospective review of our prospective database on left radial access for cerebral angiography procedures, using an extra backup catheter associated with a 4Fr vertebral catheter, performed between March and September 2019. Patient demographics, procedural and radiographic metrics as well as clinical data were recorded. RESULTS Seventy five patients with mean age of 51...years (range 21...73) underwent 80 cerebral angiographies. An average of four vessels were catheterized and mean fluoroscopy times per subject and vessel were was of 13.9 and 3.3...min, respectively. One patient required crossover to transfemoral access because of radial artery spasm. There were one asymptomatic distal radial artery occlusion and one patient presenting with asymptomatic skin blanching area on the forearm, just proximal to the tip of the sheath, that spontaneously resolved within an hour. CONCLUSION Diagnostic cerebral angiography via left radial access is feasible and safe and allows to preserve the right radial access for future neurointerventions while providing more comfort to the right handed patient.
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Affiliation(s)
- Cyril Chivot
- Department of Radiology, Amiens University Hospital, Avenue Ren.. Laennec, F-80054 Amiens Cedex 01, France.
| | - Roger Bouzerar
- Image Processing Department, Amiens University Hospital, Avenue Ren.. Laennec, F-80054 Amiens Cedex 01, France
| | - Thierry Yzet
- Department of Radiology, Amiens University Hospital, Avenue Ren.. Laennec, F-80054 Amiens Cedex 01, France
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Chen T, Yu X, Song R, Li L, Cai G. Application of ultrasound in cardiovascular intervention via the distal radial artery approach: New wine in old bottles? Front Cardiovasc Med 2022; 9:1019053. [PMID: 36588545 PMCID: PMC9799162 DOI: 10.3389/fcvm.2022.1019053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
The distal radial artery (DRA) approach has emerged as a new approach in cardiovascular intervention. In recent years, ultrasound has been widely used in cardiovascular intervention via the DRA approach. This article systematically discusses the progress of ultrasound in the preoperative vascular assessment, intraoperative guided puncture and postoperative observation of complications via the DRA approach.
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Affiliation(s)
- Tao Chen
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Department of Cardiology, Wujin Institute of Molecular Diagnostics and Precision Cancer Medicine of Jiangsu University, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Xiaolong Yu
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Ruixiao Song
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Lamei Li
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Department of Cardiology, Wujin Institute of Molecular Diagnostics and Precision Cancer Medicine of Jiangsu University, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Gaojun Cai
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Department of Cardiology, Wujin Institute of Molecular Diagnostics and Precision Cancer Medicine of Jiangsu University, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
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Safety and Effectiveness of Coronary Angiography or Intervention through the Distal Radial Access: A Meta-Analysis. J Interv Cardiol 2021; 2021:4371744. [PMID: 34867106 PMCID: PMC8604602 DOI: 10.1155/2021/4371744] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Searching the literature for coronary angiography (CAG) or intervention through distal radial access (DRA) and performing a meta-analysis. Background Coronary angiography (CAG) or intervention through distal radial access (DRA) may have a similar success rate, low radial artery occlusion rate, low radial artery spasm rate, and low rate of puncture site hematoma for patients with coronary heart disease. Therefore, the randomized controlled trials (RCTs) were searched, and the data were pooled for meta-analysis to evaluate the effectiveness and safety of DRA. Methods RCTs comparing the CAG or intervention through DRA vs. transradial access (TRA) published between January 1, 2017, and May 4, 2021, were searched in the PubMed, Embase, and Cochrane databases. The endpoints included the rate of access success and the number of radial artery occlusions, radial artery spasms, and puncture site hematomas. The data were extracted, and a random-effects model was used for analysis. Results Among 204 studies, 6 RCTs (with 2825 participants) met the inclusion criteria. Compared to TRA, the access success rate in DRA (p=0.1) and the lower rate of puncture site hematoma were not significantly different (p=0.646), while the radial artery occlusion rate (p < 0.001) and radial artery spasm rate (p=0.029) were significantly lower. Conclusion In summary, DRA has a similar access success rate and incidence of hematoma at the puncture site, but a lower incidence of RAO and spasm compared to TRA. These findings demonstrated that DRA is a safe and effective access for CAG or intervention.
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Sweid A, Weinberg JH, Khanna O, Das S, Kim J, Curtis D, Hammoud B, El Naamani K, Abbas R, Majmundar S, Sajja KC, Chalouhi N, Saiegh FA, Mouchtouris N, Atallah E, Gooch MR, Herial NA, Tjoumakaris S, Romo V, Rosenwasser RH, Jabbour P. Lessons Learned After 760 Neurointerventions via the Upper Extremity Vasculature: Pearls and Pitfalls. Neurosurgery 2021; 88:E510-E522. [PMID: 33862629 DOI: 10.1093/neuros/nyab084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The radial approach has been gaining more widespread use by neurointerventionalists fueled by data from the cardiology literature showing better safety and overall reduced morbidity. OBJECTIVE To present our institution's experience with the radial approach for neuroendovascular interventions in 614 consecutive patients who underwent a cumulative of 760 procedures. METHODS A retrospective analysis was performed and identified neuroendovascular procedures performed via the upper extremity vasculature access site. RESULTS Amongst 760 procedures, 34.2% (260) were therapeutic, and 65.7% (500) were nontherapeutic angiograms. Access sites were 71.5% (544) via a conventional radial artery, 27.8% (211) via a distal radial artery, 0.5% (4) via an ulnar artery, and 0.1% (1) via the brachial artery. Most of the procedures (96.9%) were performed via the right-sided (737), 2.9% (22) via the left-sided, and 0.1% (1) via a bilateral approach. Major access site complications occurred at a rate of 0.9% (7). The rate of transfemoral conversion was 4.7% (36). There was a statistically higher incidence of transfemoral conversion when repeat procedures were performed using the same access site. Also, there was no significant difference between nontherapeutic procedures performed using the right and left radial access, and conventional versus distal radial access. Procedural metrics improved after completion of 14 procedures, indicating a learning curve that should be surpassed by operators to reach optimal outcomes. CONCLUSION Radial artery catheterization is a safe and effective means of carrying out a wide range of neuroendovascular procedures associated with excellent clinical outcomes and an overall low rate of periprocedural complications.
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Affiliation(s)
- Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Somnath Das
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julie Kim
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Darcy Curtis
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Batoul Hammoud
- Department of Pediatric Endocrinology, Children Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Shyam Majmundar
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kalyan C Sajja
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nikolaos Mouchtouris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Victor Romo
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Rodriguez Caamaño I, Barranco-Pons R, Klass D, de Dios Las Cuevas M, Chirife OS, Aixut S. Distal Transradial Artery Access for Neuroangiography and Neurointerventions : Pitfalls and Exploring the Boundaries. Clin Neuroradiol 2021; 32:427-434. [PMID: 34258635 PMCID: PMC8276686 DOI: 10.1007/s00062-021-01039-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
Introduction The distal transradial approach (dTRA) is progressively gaining more clinical use in the fields of cardiology and other vascular interventions, as it offers a number of advantages compared to conventional radial approach (TRA). These include lower rates of vascular occlusion which permits preservation of the proximal radial artery for future procedures in the event of a distal occlusion. Aim To share the experience in the use of dTRA for neurointerventions, showing its advantages, pitfalls as well as sharing our optimized puncture and hemostatic ultrarapid compression protocols to improve the use of this vascular access. Methods A retrospective analysis of our experience of diagnostic and interventional procedures performed via dTRA using an optimized protocol for puncture and postpuncture compression of the dTRA was performed. The rate of complications (hematoma and arterial dissection at puncture site) femoral crossover, and assessment of postprocedural stenosis/occlusion with the ultrarapid compression protocol were also assessed. Results From March 2019 to July 2020 a total of 100 distal radial procedures were carried out and 53 diagnostic angiograms (53%) and 47 interventional procedures (47%) were included in the analysis. We achieved a 96% technical success, with a femoral crossover requirement in 3 cases (3%), and one conventional TRA crossover due to puncture failure. Of the patients 3 presented puncture site hematomas (3%) with no intervention required, 61 patients (61%) underwent the ultrarapid hemostasis protocol in association with a hemostatic pad. Ultrasound follow-up was performed in 20 patients (20%) at 1–2 months with 1 case of occlusion (5%) and 2 of radial stenosis (10%). In all 3 cases proximal radial artery remained patent. Conclusion The dTRA is a safe and feasible access route for angiography and neurointerventions. Using vasodilators prepuncture, we attained a variable increase in the vascular diameter facilitating puncture and reducing the risk of occlusion and vascular spasm. A rapid deflation protocol for postpuncture hemostasis does not significantly increase the hematoma rate.
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Affiliation(s)
| | | | | | | | | | - Sonia Aixut
- Hospital Universitari de Bellvitge, Barcelona, Spain
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Izumida T, Watanabe J, Yoshida R, Kotani K. Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis. World J Cardiol 2021; 13:144-154. [PMID: 34131477 PMCID: PMC8173336 DOI: 10.4330/wjc.v13.i5.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/09/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The traditional radial approach (RA) is recommended as the standard method for coronary angiography (CAG), while a distal RA (DRA) has been recently used for CAG. AIM To assess the efficacy and safety of the DRA vs RA during CAG. METHODS The following databases were searched through December 2020: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. Individual randomized-controlled trials for adult patients undergoing cardiac catheterization were included. The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm (RAS) and radial artery occlusion (RAO). Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Three randomized control trials and 13 registered trials were identified. The two approaches showed similar successful cannulation rates [risk ratio (RR) 0.90, 95% confidence interval (CI): 0.72-1.13]. The DRA did not decrease RAS (RR 0.43, 95%CI: 0.08-2.49) and RAO (RR 0.48, 95%CI: 0.18-1.29). Patients with the DRA had a shorter hemostasis time in comparison to those with the RA (mean difference -6.64, 95%CI: -10.37 to -2.90). The evidence of certainty was low. CONCLUSION For CAG, the DRA would be safer than the RA with comparable cannulation rates. Given the limited data, additional research, including studies with standard protocols, is necessary.
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Affiliation(s)
- Toshihide Izumida
- Division of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi 935-8531, Toyama, Japan
| | - Jun Watanabe
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City 329-0498, Tochigi, Japan
| | - Ryo Yoshida
- Department of Internal Medicine, Iwami Hospital, Iwami-Town 681-0003, Tottori, Japan
| | - Kazuhiko Kotani
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City 329-0498, Tochigi, Japan.
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Abd E, Alam M, Rashid H, El-Shafy Tabl M. Left distal radial artery approach versus conventional radial artery for coronary angiography. CARDIOMETRY 2021:60-66. [DOI: 10.18137/cardiometry.2021.18.6066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
We aimed to evaluate feasibility, contrast utilization and complications of trans-radial approach comparing the left distal trans-radial artery (lt. dTRA) access versus conventional right trans-radial artery (rt. TRA) access in coronary angiography. Subjects and Methods: This study was conducted on (100) patients who underwent coronary angiography (50 patients via lt. dTRA & 50 patients via rt. TRA) and was performed in the department of cardiology, Benha University Hospital. All patients performed ECG, echocardiography, arterial doppler pre and post procedures.
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11
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Distal radial access for cerebral aneurysm embolization. J Neuroradiol 2021; 49:380-384. [PMID: 33428971 DOI: 10.1016/j.neurad.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To demonstrate the feasibility and safety of distal radial access for embolization of ruptured and unruptured cerebral aneurysms. METHODS This study is a retrospective review of our prospective cerebral aneurysm embolization database. Between January and September 2019, distal radial access was considered for consecutive subjects addressed for cerebral aneurysm embolization at our institution. All procedures were performed by the same experienced operator. Technical success was defined as distal radial access with insertion of the sheath and completion of the intervention without change of access site to conventional femoral access. Primary safety endpoint was the in hospital + 30 days incidence of radial artery occlusion. Secondary endpoints included intra-procedural complications and neurologic complications at discharge and at 30 days. RESULTS Fifty-seven patients with cerebral aneurysms underwent 61 embolization procedures. Twenty eight embolizations were performed using coils, 8 used a stent-assisted coil technique, 22 used a balloon-assisted coil technique, and 3 used a flow diverter. One patient (1.6%) required crossover to femoral access. Three patients developed coil-induced thrombus that required intra-arterial Tirofiban injections. Two patients were asymptomatic and one patient presented confusion due to right frontal ischemia. One periprocedural aneurysm rupture occurred without clinical impact. Radial artery occlusion and hand ischemia were not observed. CONCLUSION Findings of the present study showed the feasibility of distal transradial access for cerebral aneurysm embolization without increasing the risk of the procedure.
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12
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Kühn AL, Singh J, de Macedo Rodrigues K, Massari F, Moholkar VM, Marwah SK, Unar D, Gounis MJ, Puri AS. Distal radial artery (Snuffbox) access for intracranial aneurysm treatment using the Woven EndoBridge (WEB) device. J Clin Neurosci 2020; 81:310-315. [DOI: 10.1016/j.jocn.2020.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/14/2020] [Accepted: 10/03/2020] [Indexed: 01/25/2023]
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13
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Kühn AL, Singh J, Moholkar VM, Satti SR, Rodrigues KDM, Massari F, Gounis MJ, McGowan A, Puri AS. Distal radial artery (snuffbox) access for carotid artery stenting - Technical pearls and procedural set-up. Interv Neuroradiol 2020; 27:241-248. [PMID: 32924692 DOI: 10.1177/1591019920959537] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To report use of distal radial artery (dRA) access for carotid artery stenting (CAS) and to discuss procedural setup and technical considerations for a successful intervention. METHODS A retrospective review of our prospective neurointerventional database of CAS was conducted between May 2019 and March 2020. All CAS cases via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data was collected. RESULTS 22 CAS procedures in 20 patients via dRA were identified. Patients' mean age was 69.4 years (range 53-87 years). 3 patients were female. Mean radial artery diameter was 2.1 mm (range 1.6-2.8 mm). dRA access was achieved in all cases. Conversion to femoral access was required in 2 cases (9.1%) due to persistent radial artery vasospasm resulting in patient discomfort despite multiple additional doses of intraarterial vasodilators and added intravenous sedation as well as tortuous vessel anatomy and limited support of the catheters in a type 3 aortic arch for left CAS. CONCLUSION Our preliminary experience with dRA access for CAS suggests this approach to be feasible and safe for patients. Technical considerations are important and preprocedural planning is necessary for a successful intervention. Catheter systems and devices specifically designed for radial access are needed to enable more interventionalists to safely perform neurointerventional procedures via wrist access.
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Affiliation(s)
- Anna Luisa Kühn
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Jasmeet Singh
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Viraj M Moholkar
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Sudhakar R Satti
- Department of Neurointerventional Surgery, Christiana Health System, Newark, DE, USA
| | - Katyucia de Macedo Rodrigues
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Francesco Massari
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Matthew J Gounis
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Archie McGowan
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
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Cai G, Huang H, Li F, Shi G, Yu X, Yu L. Distal transradial access: a review of the feasibility and safety in cardiovascular angiography and intervention. BMC Cardiovasc Disord 2020; 20:356. [PMID: 32758150 PMCID: PMC7409500 DOI: 10.1186/s12872-020-01625-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Transradial access (TRA) has been considered as the default choice in cardiac catheterization. Although infrequent, vascular complications of this approach remain. Recently, the distal transradial approach (dTRA) in cardiac catheterization was reported by interventionalists. METHODS We retrieved the relevant literatures and reviewed the safety and feasibility of this novel approach in cardiac catheterization. RESULTS The dTRA for cardiac intervention has superior safety and satisfaction. As a novel approach for cardiac catheterization, access related complications should also be considered by operators, such as RAO, radial spasm, bleeding and haematoma, and injury of the superficial branch of the radial nerve. CONCLUSIONS The dTRA in cardiovascular angiography and intervention was safe and feasible.
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Affiliation(s)
- Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Haomin Huang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Feng Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Xiaolong Yu
- Science and Education Section, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Lei Yu
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
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15
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Weinberg JH, Sweid A, Khanna O, Mouchtouris N, Asada A, Das S, Curtis D, Kim J, Romo V, Gooch MR, Herial N, Tjoumakaris S, Zarzour H, Rosenwasser RH, Jabbour P. Access Through the Anatomical Snuffbox for Neuroendovascular Procedures: A Single Institution Series. Oper Neurosurg (Hagerstown) 2020; 19:495-501. [DOI: 10.1093/ons/opaa141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/19/2020] [Indexed: 01/29/2023] Open
Abstract
Abstract
BACKGROUND
Distal transradial catheterization in the anatomic snuffbox is an alternate route of access that has started to gain consideration for neuroendovascular procedures.
OBJECTIVE
To assess the feasibility and outcomes and present our institution's experience in performing neuroendovascular procedures via distal transradial access (dTRA).
METHODS
We conducted a retrospective analysis and identified 120 patients who underwent consecutive neuroendovascular procedures via dTRA in the anatomic snuffbox. Data collection was performed on indication for procedure, sheath size, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, conversion to femoral approach, access site complication, and procedure success.
RESULTS
Of 120 patients with an average age of 54.7 yr ± 14.7, 73 (60.8%) underwent diagnostic angiograms, 38 (31.7%) underwent follow-up angiograms, and 9 (7.5%) underwent therapeutic procedures. The overall mean number of vessels catheterized was 2.5 ± 0.1 per procedure, the mean procedure time was 68.3 min ± 43.4, the mean fluoroscopy time was 10.8 min ± 7.6, the mean contrast dose was 70.6 mL ± 39.1, and the mean radiation exposure was 27 672.2 mGycm2 ± 42 728.4. Successfully completed therapeutic procedures included aneurysm 1 (0.8%), arteriovenous malformation (AVM)/arteriovenous fistula/carotid cavernous fistula 7 (5.8%), and 1 (0.8%) other treatment. Three patients (2.5%) required adjunct transfemoral endovenous access for AVM embolization. Two minor complications (1.67%) were a local wrist hematoma and a radial artery vasospasm without any sequelae.
CONCLUSION
Distal radial artery catheterization in the anatomic snuffbox is a safe and effective access site to perform neuroendovascular procedures. Complications and conversion rate are low making it a safe alternative.
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Affiliation(s)
- Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nikolaos Mouchtouris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ashlee Asada
- Drexel University College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Somnath Das
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Darcy Curtis
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julie Kim
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victor Romo
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nabeel Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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16
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Kühn AL, de Macedo Rodrigues K, Singh J, Massari F, Puri AS. Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study. J Neurointerv Surg 2020; 12:798-801. [PMID: 31915209 DOI: 10.1136/neurintsurg-2019-015604] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/08/2019] [Accepted: 12/15/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To report the first use of distal radial artery (dRA) access for a variety of neurointerventions and to demonstrate the safety and feasibility of this approach. METHODS A retrospective review of our prospective neurointerventional database of endovascular interventions was conducted and, between May and October 2019, all patients in whom the intervention was performed via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data were collected. RESULTS 48 patients with a mean age of 64.4 years (range 35-84 years) were included. 27 patients were female. dRA access was achieved in all cases. Conversion to femoral access was required in five cases (10.4%) due to tortuous vessel anatomy and limited support of the catheters in the aortic arch. Interventions performed included aneurysm treatment (with flow diverters, Woven EndoBridge device placement, coiling or stent-assisted coiling), arteriovenous malformation and dural arteriovenous fistula embolization, carotid artery stentings, stroke thrombectomy, thrombolysis for central retinal artery occlusion, intracranial stenting, middle meningeal artery embolization, vasospasm treatment, and spinal angiography with embolization. Radial artery vasospasm was seen in two cases and successfully treated with antispasmolytic medication. No symptomatic radial artery occlusion or ischemic event was observed. CONCLUSION dRA access is safe and effective for a variety of neurointerventions. Our preliminary experience with this approach is very promising and shows high patient satisfaction.
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Affiliation(s)
- Anna Luisa Kühn
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Katyucia de Macedo Rodrigues
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jasmeet Singh
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Francesco Massari
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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17
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Brunet MC, Chen SH, Sur S, McCarthy DJ, Snelling B, Yavagal DR, Starke RM, Peterson EC. Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography. J Neurointerv Surg 2019; 11:710-713. [PMID: 30814329 DOI: 10.1136/neurintsurg-2019-014718] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND The transradial approach for endovascular angiography and interventional procedures is superior to the traditional transfemoral approach in several metrics, including lower access-site complication rates, higher patient satisfaction, and lower hospital costs. Interventional cardiologists have begun to adopt the distal transradial approach (dTRA) for coronary interventions as it has an improved safety profile and improved procedural ergonomics. Adaptation of dTRA for neuroendovascular procedures promises similar benefit, but requires a learning curve. OBJECTIVE To report the first use of dTRA for diagnostic cerebral angiography and demonstrate the feasibility and safety of a dTRA. METHODS A retrospective review of our prospective institutional database of consecutive cases of cerebral DSA performed via dTRA between August 2018 and December 2018 was performed. Patient demographics, procedural and radiographic metrics, and clinical data were recorded. RESULTS 85 patients were identified with an average age of 53.8 years (range 18-82); 67 (78.8%) patients were female. 78 patients underwent successful dTRA diagnostic cerebral angiography, with a mean of five vessels catheterized and average fluoroscopy time of 12.0 min, or 2.6 min for each vessel. Seven patients required conversion to transfemoral access, with the most common reason being inability to advance the wire and radial artery spasm. There were no complications. CONCLUSION dTRA is associated with decreased rates of radial artery occlusion, ischemic hand events, as well as improved patient comfort, faster periprocedural management, and cost benefits. Our preliminary experience with dTRA for diagnostic cerebral angiography demonstrates excellent feasibility and safety in combination with relative efficiency.
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Affiliation(s)
- Marie-Christine Brunet
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Stephanie H Chen
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Samir Sur
- Neurological Surgery, University of Miami MILLER School of Medicine, Miami, Florida, USA
| | - David J McCarthy
- Neurosurgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Brian Snelling
- Neurological Surgery, University of Miami MILLER School of Medicine, Miami, Florida, USA
| | - Dileep R Yavagal
- Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.,University of Miami School of Medicine, Miami, Florida, USA
| | - Eric C Peterson
- Neurological Surgery, University of Miami MILLER School of Medicine, Miami, Florida, USA
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