Predicting the Degree of Difficulty of the Trans-Radial Approach in Cerebral Angiography. (16th November 2020)

• Record Type: Journal Article
• Authors: Khan, Nickalus; Arthur, Adam S; Peterson, Eric; Jabbour, Pascal; Nguyen, Vincent; Dornbos, David L; Peterson, Jeremy C; Hoit, Daniel; Nickele, Christopher; Elijovich, Lucas; Inoa-Acosta, Violiza; Torabi, Radmehr; Goyal, Nitin; Morris, David
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_284
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: There has been a recent shift from trans-femoral access (TFA) to trans-radial access (TRA) in interventional cardiology and more recently in neurointervention. There are clear benefits to patients, including a reduction in serious access site complications, decreased length of stay, decreased cost, and improved patient satisfaction. Despite these benefits, there are cases in which trans-radial cerebral angiography can prove difficult, requiring conversion to alternative access, even for the most experienced of operators. The purpose of this study was to analyze the relationship between several anatomical variables and measures of angiography difficulty. METHODS: A total of 52 trans-radial diagnostic angiograms were evaluated in a tertiary care stroke center from December 2019 until March 2020. We analyzed a number of anatomical variables to evaluate for correlation to outcome measures of angiography difficulty. RESULTS: The presence of a proximal radial loop had a higher conversion to femoral access ( P < . 03). A large diameter aortic arch ( P < . 007), a double subclavian innominate curve ( P < . 012), the presence of a proximal CCA loop ( P < . 001), an acute left subclavian vertebral angle ( P = . 014), and type of aortic arch ( P < . 021) were all associated with more difficult trans-radial cerebral angiography and increased fluoroscopy time per vessel. CONCLUSION: The presence of a proximal radial loop, large diameter aortic arch, a double subclavian innominate curve, a proximal CCA loop, an acute left subclavian vertebral angle, and type of aortic arch were associated with more difficult trans-radial cerebral angiography. A novel grading scale for diagnostic trans-radial angiography is introduced.