Arterial Access Site Complications in Transradial Neurointerventions
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Arterial Access Site Complications in Transradial Neurointerventions Single Center Review of 750 Consecutive Cases Matthew T. Crockett1 Timothy J. Phillips1
· Gregory D. Selkirk1 · Albert HY Chiu1 · Tejinder P. Singh1 · William McAuliffe1 ·
Received: 26 September 2019 / Accepted: 25 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Introduction Transradial access for cardiac intervention results in lower rates of access site complications and major bleeding events in comparison to transfemoral access, with an associated reduction in all-cause mortality, morbidity and length of hospital stay [1]. Recent advances in low-profile access sheaths and neurospecific guide catheters have led to a surge of interest in transradial access for neurointerventions; however, rates of radial access site complications following neurointerventional procedures are yet to be defined. This article describes the radial artery access and closure techniques and provides data prospectively collected on radial access complications from over 750 consecutive transradial cases at a high volume neurointerventional center.
Methods Patient Selection and Data Collection Data on all transradial neurointerventional cases were prospectively recorded in the local registry following introduction of the technique in July 2018. In all cases the decision on whether to undertake transradial access was at the discretion of the operating neurointerventionalist. The only prerequisite to performing a procedure via transradial access was a patent radial artery on preprocedural palpation and ultrasound examination. A preprocedural modified Allen or Barbeau test was not performed given
that recent studies in interventional cardiology have shown that abnormal tests should not preclude transradial access [2–4].
Transradial Access Technique All radial artery punctures were performed under ultrasound guidance using a volar or snuffbox approach both of which have been previously well-described [5, 6]. Low profile radial sheaths were utilized for the majority of cases, either Glidesheath Slender (Terumo, Tokyo, Japan) or Prelude Ideal (Merit, South Jordan, UT, USA). Radial access sheath sizes varied depending on the procedure, where 4 Fr or 5 Fr sheaths were used for diagnostic cerebral angiography, 6 Fr sheaths were used for the majority of intracranial aneurysm treatments and internal carotid artery stents and 7 Fr sheaths for posterior circulation and anterior circulation stroke interventions. A proportion of anterior circulation stroke interventions were performed via 8 Fr access by exchanging a 7 Fr low-profile radial sheath for an 8 Fr AXIS Infinity sheath (Stryker, Kalamazoo, MI, USA) over a 0.035 inch guidewire. Following sheath insertion, a combination of glyceryl trinitrate (GTN) and verapamil was instilled directly through the sheath into the radial artery to minimize vasospasm. In elective transradial cases, 100–200 µg GTN and 2.5–5 mg verapamil were administered prophylactically to all patients; however, in the
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