Korean J Radiol.  2006 Mar;7(1):7-13. 10.3348/kjr.2006.7.1.7.

Feasibility and Utility of Transradial Cerebral Angiograpy: Experience during the Learning Period

• Kim JH
• Park YS
• Chung CG
• Park KS
• Chung DJ
• Kim HJ

• KMID: 753910
• DOI: http://doi.org/10.3348/kjr.2006.7.1.7

Abstract

OBJECTIVE
We wanted to present our experiences for performing transradial cerebral angiography during the learning period, and we also wanted to demonstrate this procedure's technical feasibility and utility in various clinical situations. MATERIALS AND METHODS: Thirty-two patients were enrolled in the study. All of them had unfavorable situations for performing transfemoral angiography, i.e., IV lines in the bilateral femoral vein, a phobia for groin puncture, decreased blood platelet counts, large hematoma or bruise, atherosclerosis in the bilateral femoral artery and the insistence of patients for choosing another procedure. After confirming the patency of the ulnar artery with a modified Allen's test and a pulse oximeter, the procedure was done using a 21-G micorpuncture set and 5-F Simon II catheters. After angiography, hemostasis was achieved with 1-2 minutes of manual compression and the subsequent application of a hospital-made wrist brace for two hours. The technical feasiblity and procedure-related immediate and delayed complications were evaluated. RESULTS: The procedure was successful in 30/32 patients (93.8%). Failure occurred in two patients; one patient had hypoplasia of the radial artery and one patient had vasospasm following multiple puncture trials for the radial artery. Transradial cerebral angiography was technically feasible without significant difficulties even though it was tried during the learning period. Pain in the forearm or arm developed in some patients during the procedures, but this was usually mild and transient. Procedure-related immediate complications included severe bruising in one patient and a small hematoma in one patient. Any clinically significant complication or delayed complication such as radial artery occlusion was not demonstrated in our series. CONCLUSION: Transradial cerebral angiography is a useful alternative for the patients who have unfavorable clinical situations or contraindications for performing transfemoral cerebral angiography. For the experienced neurointerventionalists, it seems that additional training for perfoming transradial cerebral angiography is not needed.

Keyword

Angiography; Cerebral blood vessel; Diagnosis; Radial artery; Technique

MeSH Terms

Subarachnoid Hemorrhage/radiography
Radial Artery
Middle Aged
Male
Intracranial Hemorrhages/radiography
Humans
Female
Feasibility Studies
Cerebral Angiography/*methods
Catheterization/*methods
Aged
Adult

Figure

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  Fig. 1 Due to groin phobia, this 44-year-old male patient underwent transradial cerebral angiography. A. A 5-F introducer sheath was inserted into the radial artery. B. A 0.035-inch guide wire was passed though the radial and brachial arteries. C. A guide wire and a 5-F Simon II catheter were introduced into the ascending aorta. D. The guide wire was turned back at the aortic valve. E. A J-curve was made at the distal portion of the Simon II catheter.

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  Fig. 2 When handling the catheter, the brain supplying arteries can be easily selected. A. Left common carotid artery, B. Left internal carotid artery, C. Right common and internal carotid artery, D. Left vertebral artery.

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  Fig. 3 A. During catheter handling to select the right common carotid artery, the catheter kinked because of excessive torque. The innominate artery was very tortuous in this patient. B. The catheter was withdrawn. Focal kinking is demonstrated in the catheter.

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  Fig. 4 During guide wire insertion through the radial artery, it entered the radial recurrent artery, causing sharp pain in the forearm.

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