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Distal Transradial Artery Access for Neuroangiography and Neurointerventions: Pitfalls and Exploring the Boundaries

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 perm...

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Autores principales: Rodriguez Caamaño, Isabel, Barranco-Pons, Roger, Klass, Darren, de Dios las Cuevas, Marta, Chirife, Oscar Sabino, Aixut, Sonia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276686/
https://www.ncbi.nlm.nih.gov/pubmed/34258635
http://dx.doi.org/10.1007/s00062-021-01039-9
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author Rodriguez Caamaño, Isabel
Barranco-Pons, Roger
Klass, Darren
de Dios las Cuevas, Marta
Chirife, Oscar Sabino
Aixut, Sonia
author_facet Rodriguez Caamaño, Isabel
Barranco-Pons, Roger
Klass, Darren
de Dios las Cuevas, Marta
Chirife, Oscar Sabino
Aixut, Sonia
author_sort Rodriguez Caamaño, Isabel
collection PubMed
description 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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spelling pubmed-82766862021-07-14 Distal Transradial Artery Access for Neuroangiography and Neurointerventions: Pitfalls and Exploring the Boundaries Rodriguez Caamaño, Isabel Barranco-Pons, Roger Klass, Darren de Dios las Cuevas, Marta Chirife, Oscar Sabino Aixut, Sonia Clin Neuroradiol Original Article 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. Springer Berlin Heidelberg 2021-07-13 2022 /pmc/articles/PMC8276686/ /pubmed/34258635 http://dx.doi.org/10.1007/s00062-021-01039-9 Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
Rodriguez Caamaño, Isabel
Barranco-Pons, Roger
Klass, Darren
de Dios las Cuevas, Marta
Chirife, Oscar Sabino
Aixut, Sonia
Distal Transradial Artery Access for Neuroangiography and Neurointerventions: Pitfalls and Exploring the Boundaries
title Distal Transradial Artery Access for Neuroangiography and Neurointerventions: Pitfalls and Exploring the Boundaries
title_full Distal Transradial Artery Access for Neuroangiography and Neurointerventions: Pitfalls and Exploring the Boundaries
title_fullStr Distal Transradial Artery Access for Neuroangiography and Neurointerventions: Pitfalls and Exploring the Boundaries
title_full_unstemmed Distal Transradial Artery Access for Neuroangiography and Neurointerventions: Pitfalls and Exploring the Boundaries
title_short Distal Transradial Artery Access for Neuroangiography and Neurointerventions: Pitfalls and Exploring the Boundaries
title_sort distal transradial artery access for neuroangiography and neurointerventions: pitfalls and exploring the boundaries
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276686/
https://www.ncbi.nlm.nih.gov/pubmed/34258635
http://dx.doi.org/10.1007/s00062-021-01039-9
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