Neurointervention.  2015 Sep;10(2):74-81. 10.5469/neuroint.2015.10.2.74.

Feasibility of the Transradial or the Transbrachial Approach in Various Neurointerventional Procedures

• Lee DG
• Lee DH
• Shim JH
• Suh DC

• KMID: 2148997
• DOI: http://doi.org/10.5469/neuroint.2015.10.2.74

Abstract

PURPOSE
The generally preferred vascular access for neurointerventional procedures is the transfemoral approach (TFA). In complicated cases such as patients with aortic diseases or tortuous vessels, transradial or transbrachial approaches (TRA or TBA) could be good alternatives. The purpose of this study is to review a single medical center experience using the alternative accesses.
MATERIALS AND METHODS
We reviewed the medical records of 30 TRA and 10 TBA cases among 2,073 cases treated between January 2010 and July 2013. We reviewed and analyzed the frequency of TRA and TBA, the reason the operator had chosen the TRA or TBA, the category of the procedure, caliber of the sheath, the success rate, and the complications rates.
RESULTS
The most common reason the non-TFA route was chosen was due to the patient's tortuous vascular system (n=24, 60%). The most common category of intervention was balloon angioplasty and/or stent placement (n=18, 45%). The largest caliber of the introducing sheath was 6 Fr in TRA and 7 Fr in TBA. Procedural success was achieved in 37 cases (success rate: 92.5%), and in three cases it failed. Six patients with complications were reported. Among them, four cases of minor complications (10%) occurred. There was no serious complication directly related to the access problem.
CONCLUSION
Both TRA and TBA can be good alternative access routes when TFA is not appropriate in various neurointervential procedures.

Keyword

Therapeutic/methods; Endovascular technique; Transradial approach; Transbrachial approach; Transfemoral approach

MeSH Terms

Angioplasty, Balloon
Aortic Diseases
Endovascular Procedures
Humans
Medical Records
Stents

Figure

• 

  Fig. 1 A 73-year-old man with stenosis of the right, vertebral artery ostium.A. The right, vertebral artery angiogram reveals severe stenosis of the right vertebral artery ostium.B. Using a transradial approach, we could perform balloon angioplasty and stent deployment. It took 18 minutes from the puncture to the final angiography.

• 

  Fig. 2 Vessels of interest.ACA, Anterior cerebral artery; PCA, posterior cerebral artery; MCA, middle cerebral artery; BA, basilar artery; VA, vertebral artery; ICA, internal cerebral artery; ECA, external cerebral artery

• 

  Fig. 3 A 62-year-old woman with a mycotic aneurysm of the right posterior cerebral artery. The microcatheter (arrow head) could not navigate into the mycotic aneurysm (black arrow) because of the very acute angulation (white arrow) of the posterior cerebral artery.

• 

  Fig. 4 A 74-year-old woman with an unruptured aneurysm of the right anterior cerebral arteryA. The right internal carotid angiogram reveals a 12-mm × 9-mm, saccular aneurysm (black arrow) arising from the A2 segment of the right anterior cerebral artery.B. Using a transfemoral approach, we could not secure stable guiding because of the tortuous vascular system.C, D. Using a transbrachial approach, we could easily select the right internal carotid artery with stable guiding support. The tip of the guiding catheter (white arrow) is located in the internal cerebral artery.

Reference

1. Lee DH, Ahn JH, Jeong SS, Eo KS, Park MS. Routine transradial access for conventional cerebral angiography: a single operator's experience of its feasibility and safety. Br J Radiol. 2004; 77:831–838. PMID: 15482994.

2. Kim JH, Park YS, Chung CG, Park KS, Chung DJ, Kim HJ. Feasibility and utility of transradial cerebral angiography: experience during the learning period. Korean J Radiol. 2006; 7:7–13. PMID: 16549950.

3. Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures: Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004; 44:349–356. PMID: 15261930.

4. Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377:1409–1420. PMID: 21470671.

5. Brueck M, Bandorski D, Kramer W, Wieczorek M, Holtgen R, Tillmanns H. A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. JACC Cardiovasc Interv. 2009; 2:1047–1054. PMID: 19926042.

6. Cooper CJ, El-Shiekh RA, Cohen DJ, Blaesing L, Burket MW, Basu A, et al. Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison. Am Heart J. 1999; 138(3 Pt 1):430–436. PMID: 10467191.

7. Mann JT 3rd, Cubeddu MG, Schneider JE, Arrowood M. Right Radial Access for PTCA: A Prospective Study Demonstrates Reduced Complications and Hospital Charges. J Invasive Cardiol. 1996; 8(Suppl D):40D–44D.

8. Louvard Y, Pezzano M, Scheers L, Koukoui F, Marien C, Benaim R, et al. Coronary angiography by a radial artery approach: feasibility, learning curve. One operator's experience. Arch Mal Coeur Vaiss. 1998; 91:209–215. PMID: 9749247.

9. Goldberg SL, Renslo R, Sinow R, French WJ. Learning curve in the use of the radial artery as vascular access in the performance of percutaneous transluminal coronary angioplasty. Cathet Cardiovasc Diagn. 1998; 44:147–152. PMID: 9637436.

10. Park S, Kwak JH, Baek HJ, Park JW, Kim JS, Suh DC. The Use of Protection Device in Landmark-wire Technique of Symptomatic Subclavian Artery Occlusion with Combined Approach via Trans-femoral vs. Trans-brachial Arteries: Technical note. Neurointervention. 2011; 6:89–89. PMID: 22125755.

11. Allen E. Thromboangiitis obliterans: methods of diagnosis of chronic occlusive arterial lesions distal to the wrist with illustrative cases. Am J Med Sci. 1929; 178:8.

12. Gunasekaran S, Kallarakkal JT, Thanikachalam S. Percutaneous transluminal coronary angioplasty by right transradial approach in a patient with arteria lusoria. Indian Heart J. 2006; 58:365–367. PMID: 19039159.

13. Layton KF, Kallmes DF, Cloft HJ. The radial artery access site for interventional neuroradiology procedures. AJNR Am J Neuroradiol. 2006; 27:1151–1154. PMID: 16687562.

14. Levy EI, Kim SH, Bendok BR, Qureshi AI, Guterman LR, Hopkins LN. Transradial stenting of the cervical internal carotid artery: technical case report. Neurosurgery. 2003; 53:448–451. PMID: 12925267.

15. Saito S, Miyake S, Hosokawa G, Tanaka S, Kawamitsu K, Kaneda H, et al. Transradial coronary intervention in Japanese patients. Catheter Cardiovasc Interv. 1999; 46:37–41. PMID: 10348564.

16. De Leon D, Swank G, Mirza MA. Radial artery sterile granulomatous reaction secondary to hydrophilic-coated sheath used for transradial cardiac catheterization: a case series. Angiology. 2012; 63:560–562. PMID: 22323832.

17. Rathore S, Stables RH, Pauriah M, Hakeem A, Mills JD, Palmer ND, et al. Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomized study. JACC Cardiovasc Interv. 2010; 3:475–483. PMID: 20488402.

18. Sakai H, Ikeda S, Harada T, Yonashiro S, Ozumi K, Ohe H, et al. Limitations of successive transradial approach in the same arm: the Japanese experience. Catheter Cardiovasc Interv. 2001; 54:204–208. PMID: 11590685.

19. Jo KW, Park SM, Kim SD, Kim SR, Baik MW, Kim YW. Is Transradial Cerebral Angiography Feasible and Safe? A Single Center's Experience. J Korean Neurosurg Soc. 2010; 47:332–333. PMID: 20539791.

20. Guedes A, Dangoisse V, Gabriel L, Jamart J, Chenu P, Marchandise B, et al. Low rate of conversion to transfemoral approach when attempting both radial arteries for coronary angiography and percutaneous coronary intervention: a study of 1,826 consecutive procedures. J Invasive Cardiol. 2010; 22:391–397. PMID: 20814043.

21. Moran CJ, Milburn JM, Cross DT 3rd, Derdeyn CP, Dobbie TK, Littenberg B. Randomized controlled trial of sheaths in diagnostic neuroangiography. Radiology. 2001; 218:183–187. PMID: 11152799.