Transradial Cerebral Angiography Research Articles

Transradial Diagnostic Cerebral Angiography: Local Experience, Technique, and Outcomes

Transradial Diagnostic Cerebral Angiography: Local Experience, Technique, and Outcomes

Pigtail catheter exchange technique for the Simmons catheter formation in transradial cerebral angiography

BackgroundThe transradial approach (TRA) has become popular for diagnostic cerebral angiography. However, this approach is still used less often because of problematic formation of the Simmons catheter. The purpose of this study was to introduce a pigtail catheter exchange technique for Simmons catheter formation to improve the success rates with a shorter operation time and without increasing complications. MethodsThis retrospective study included consecutive patients eligible for right TRA cerebral angiography at our institution from 2021. To introduce the technique, the cerebral angiogram of formation of the Simmons catheter in the type II aortic arch was constructed. Patient demographic and angiographic data were collected. ResultsIn total, 295 cerebral angiographies were evaluated. There were 155 (52.5 %), 83 (28.1 %), 39 (13.2 %), and 18 (6.1 %) patients with types I, II, and III aortic arches and bovine arch, respectively. The total fluoroscopy time, operation time and radiation exposure were 6.3 ± 4.4 min, 17.7 ± 8.3 min and 559.2 ± 197.3 mGy, respectively. The Simmons catheter was successfully formed in 294 of 295 patients, with a success rate of 99.6 %, confirming an effective technique for right TRA cerebral angiography. No severe complications were observed in any patient. ConclusionsPigtail catheter exchange may be an effective and safe technique for right TRA cerebral angiography. The findings of this report prompted institutions to apply this technique clinically and can serve as a basis for future trials focused on TRA cerebral angiography.

Transradial Cerebral Angiography: Is it Feasible and Safe for Children?

To investigate the feasibility and safety of transradial cerebral angiography (TRCA) in comparison to transfemoral cerebral angiography (TFCA) in the pediatric population. We retrospectively reviewed pediatric patients who underwent TRCA between January 2019 and July 2020. Patients with TFCA experience were examined. Pre- and post-procedural Doppler ultrasonography was performed to evaluate TRCA complications. To evaluate differences in radiation exposure between TRCA and TFCA, we investigated the radiation dose, dose area product (DAP), fluoroscopy time, and examination time. Thirty-five patients (mean age, 13.8years; 22 male) underwent TRCA, with 18 (mean age, 13.0years; 10 male) experiencing TFCA. TRCA was successful in all cases without technical failure. Radiation exposure including radiation dose and DAP were significantly higher in the TRCA group (474.1mGy and 8299.6μGy m2) compared with the TFCA group (347.8mGy and 6342.0μGy m2). Fluoroscopy time and total examination time were significantly longer (145.1% and 32.6%) in TRCA (15.2 and 38.6min) group compared with the TFCA group (6.2 and 29.1min). Among the 26 patients who underwent post-procedural Doppler ultrasonography, five (19.2%) had complications after TRCA. Two (7.7%) patients showed radial artery stenosis, two (7.7%) had hematoma at the puncture site, and one (3.8%) showed thrombotic occlusion. Although TRCA is a technically feasible and safe method in pediatric patients, high radiation exposure to TFCA must be considered. Therefore, it should be considered as an alternative method in those with unfavorable clinical situations for performing TFCA. Level 4, Case Series.

Microsurgical Clip Reconstruction of a Ruptured Internal Carotid Artery Terminus Blister Aneurysm Using a Reverse Picket Fence Technique.

Blister aneurysms are rare, technically challenging lesions that are typically ill defined and arise at nonbranch points of arteries. To describe the microsurgical treatment of a ruptured blister aneurysm at the internal carotid artery (ICA) terminus using the reverse picket fence clipping technique. The patient was a 60-yr-old male. He presented with a Hunt and Hess Grade 2, Fisher Grade 3 subarachnoid hemorrhage located in the bilateral sylvian fissures (right>left) and suprasellar cisterns. Computed tomography angiography demonstrated 2 aneurysms: a 2-mm right middle cerebral artery (MCA) aneurysm and a 2.5-mm right internal carotid artery (ICA) terminus blister aneurysm. Transradial cerebral angiography was undertaken which showed these similar sized aneurysms. Microsurgical treatment was chosen, and the patient underwent a right pterional craniotomy for clipping of his aneurysms. The patient consented to the procedure. The combination of stacked fenestrated clips repaired the vessel, with intraoperative fluorescein and indocyanine green angiography demonstrated normal filling of the MCA and ICA circulation with no delay. Intraoperative angiography confirmed induced moderate stenosis of the ICA terminus at about 50%, which is essential to close the blister aneurysm site by utilizing a portion of the normal vessel wall. Ruptured blister aneurysms at the ICA terminus can be safely repaired using the reverse picket fence technique for clipping.

Transradial cerebral angiography becomes more efficient than transfemoral angiography: lessons from 500 consecutive angiograms

BackgroundTransradial arterial access (TRA) for cerebral diagnostic angiography is associated with fewer access site complications than transfemoral access (TFA). However, concerns about increased procedure time and radiation exposure with TRA...

Entrapment of modified Simmonds catheter by aortic valve using turn-over technique. A case report

BackgroundTurn-over technique of Simmonds catheter by aortic valve is widely used not only for diagnostic transradial cerebral angiography (TRA), but transfemoral endovascular treatment for patients who has a difficulty of catheter access to cerebral arteries. We herein report a rare complication of entrapment of modified Simmonds catheter using turn-over technique with aortic valve that was assumed that the catheter passed through the fenestrated aortic valve and were entrapped to become difficult to remove. Case descriptionA 66-year-old woman underwent diagnostic TRA. A 4Fr modified Simmonds catheter was advanced to the ascending aorta under fluoroscopic guidance. A guidewire was turned over at the aortic valve to form a modified Simmonds catheter shape. The catheter was stuck when pulled to be hooked on the major aortic bifurcation. The Simmonds catheter was finally withdrawn and removed using supportive stiff wire. Transthoracic echocardiography performed after the procedure revealed jet-like leaking between the cusps, suggesting fenestration of the aortic valve. It is assumed that the catheter was entrapped by the aortic valve because the guidewire accidentally passed through the small fenestrated aortic valve that had already existed and the catheter was advanced through the fenestrated aortic valve. ConclusionWe experienced a rare technical pitfall of entrapment of modified Simmonds catheter by aortic valve using turn-over technique. Clinicians should be aware of a rare complication may occur during endovascular intervention.

Predicting the degree of difficulty of the trans-radial approach in cerebral angiography

BackgroundTo evaluate anatomical and clinical factors that make trans-radial cerebral angiography more difficult.MethodsA total of 52 trans-radial diagnostic angiograms were evaluated in a tertiary care stroke center from December 2019...

Radial access for neurointervention: room set-up and technique for diagnostic angiography

A number of prospective randomized trials have shown that the radial artery is a safer access site than the femoral artery for endovascular procedures.1–4 In the cardiac literature there was...

Comparison of transradial and transfemoral cerebral angiography

ObjectivesTo compare the feasibility, safety and effectiveness of transradial and transfemoral artery puncture cerebral angiography. MethodsThe clinical data of 30 cases (radial artery group) and 256 cases (femoral artery group) of cerebrovascular angiography through radial artery puncture were retrospectively analyzed, and the puncture success rate, angiography time, exposure time and surgical complication rate were compared. ResultsThere was no significant difference in the success rate of puncture between the two groups (P > 0.05). The procedure time and radiation exposed time were longer than those in the femoral artery group (P < 0.05). The incidence of hematoma in the radial artery group was lower than femoral artery group (P < 0.05), but the incidence of vasospasm was higher than femoral artery group (P < 0.05). ConclusionCompared with traditional angiography through femoral artery puncture, the procedure time and duration of angiography through radial artery puncture were slightly longer, and the incidence of postoperative vasospasm was slightly higher, but the trauma was small, the incidence of hematoma at puncture site was low, and the patients did not need to stay in bed, which were applicable to patients with different needs.

Placement of the Woven EndoBridge (WEB) device via distal transradial access in the anatomical snuffbox: A technical note

The distal transradial access in the anatomical snuffbox for neurovascular procedures is a modification of the radial access with an improved safety profile and patient comfort compared to the conventional transradial access. However, its use has been limited to diagnostic cerebral angiography, but not aneurysm treatment.We present the first case of a 53-year-old female whose work-up for headaches showed an anterior communicating artery aneurysm. The patient underwent distal transradial cerebral angiography and subsequent placement of a Woven EndoBridge (WEB) device for treatment of the aneurysm through the same access site. The procedure was uneventful and the patient was discharged home neurologically intact. Her hand remained warm, well-perfused, and with no visible or palpable hematoma.Our report illustrates the feasibility of the distal TRA for the treatment of cerebral aneurysms using the WEB device. Further studies are necessary to confirm the additional benefits of the distal TRA over TRA for neurovascular access.

Efficacy and Safety of a Novel Catheter for Transradial Cerebral Angiography

The goal of this study is to evaluate the safety and efficacy of a novel catheter for right radial artery approach cerebral angiography. Patients from the Neurology Department of The Second Affiliated Hospital of Guangxi Traditional Chinese Medical University who underwent diagnostic cerebral angiography of either the left vertebral artery dominant type or balanced type were enrolled in this study. A total of 167 patients were treated between February 2016 and December 2017, of whom 44 were excluded based on study exclusion criteria and 123 were enrolled in the present analysis. Bilateral subclavian artery catheterization and bilateral common carotid artery catheterization were conducted successfully in all 123 patients. The success rate of selective catheterization of the left vertebral artery was 87.8% (108/123). The success rate of selective catheterization of the right vertebral artery using the novel catheter was 89.0% (73/82). The average fluoroscopy time was 6.5±3.4min, the average operation duration was 47±3.7 (range 50-90) min, and the average dosage of contrast agent was 112.3±8.1mL. One patient exhibited an absence of pulse in the punctual radial artery after the removal of the arterial compression band, but there was no evidence of ischemia of the distal hand. One patient who was undergoing dual anti-platelet drug treatment suffered from bleeding at the puncture point when deflated for 2hr after operation; this patient was re-pressurized and re-timed. This novel catheter improved the success rate of selective left vertebral artery catheterization, and allowed for simplification of the relevant surgical steps. The controllability of this novel catheter was satisfactory, and its associated surgical risk was found to be low.

Transradial cerebral angiography: techniques and outcomes

BackgroundDespite several retrospective studies analyzing the safety and efficacy of transradial access (TRA) versus transfemoral access (TFA) for cerebral angiography, this transition for neurointerventional procedures has been gradual. Nonetheless, based...

Complications Following Transradial Cerebral Angiography : An Ultrasound Follow-Up Study.

ObjectiveThe feasibility and usefulness of transradial catheterization for coronary and neuro-intervention are well known. However, the anatomical change in the catheterized radial artery (RA) is not well understood. Herein, we present the results of ultrasonographic observation of the RA after routine transradial cerebral angiography (TRCA). MethodsPatients who underwent routine TRCA with pre- and post-procedure Doppler ultrasonography (DUS) of the catheterized RA were enrolled. We then recorded and retrospectively reviewed the diameter and any complicated features of the RA observed on DUS, and the factors associated with the diameter and complications were analyzed. ResultsA total of 223 TRCAs across 181 patients were enrolled in the current study. The mean RA diameter was 2.48 mm and was positively correlated with male gender (p<0.001) and hypertension (p<0.002). The median change in diameter after TRCA was less than 0.1 mm (range, -1.3 to 1.2 mm) and 90% of changes were between -0.8 and +0.7 mm. Across 228 procedures, there were 12 cases (5.3%) of intimal hyperplasia and 22 cases (9.6%) of asymptomatic local vascular complications found on DUS. Patients with abnormal findings on the first procedure had a smaller pre-procedural RA diameter than that of patients without findings (2.26 vs. 2.53 mm, p=0.0028). There was no significant difference in the incidence of abnormal findings for the first versus subsequent procedures (p=0.68). ConclusionDUS identified the pre- and post-procedural diameter and local complications of RA. Routine TRCA seems to be acceptable with regard to identifying local complications and changes in RA diameter.

Elevated white blood cell count is associated with clot formation within arterial sheaths and may be a risk factor for thromboembolic complication during transradial cerebral angiography

Elevated white blood cell count is associated with clot formation within arterial sheaths and may be a risk factor for thromboembolic complication during transradial cerebral angiography

Efficacy of transradial cerebral angiography in the elderly.

ObjectiveTransradial angiography has become popular among many cardiologists as a diagnostic and therapeutic tool. However, transradial cerebral angiography is not utilized to the same extent. The purpose of this study is to present our experience regarding the usefulness of transradial cerebral angiography, especially in elderly patients.MethodsBetween May 2011 and February 2012, a total of 126 cerebral angiographies were performed via a transradial approach in a single center. Of them, only 47 patients were over 60 years old. In our institution, we shifted the initial access from the right femoral artery to the right radial artery in all patients requiring cerebral angiography in 2011. We did not attempt radial access in 40 cases for variable reasons.ResultsThe procedural success rate was 92.2%. We have four failures of transradial angiography; two because of loop formations of the radial and brachial artery and two due to multiple puncture failures. All supra-aortic vessels were successfully catheterized. However, the selective catheterization rates of the left side distal vessels were lower, as success rates were 89.7% for the right internal carotid artery and 75% for the left internal carotid artery. Procedure-related vascular complications, such as puncture site hematoma, hand ischemia, pseudoaneurysm, arteriovenous fistula and arterial dissection were not observed in our series. However, intraprocedural thrombosis developed in one patient, which was resolved completely by intraarterial thrombolytic agents.ConclusionWith advancing patient's age, we believe that transradial cerebral angiography is a useful tool to decrease patient's discomfort and more effectively manage the vessel tortuosity.

Is Transradial Cerebral Angiography Feasible and Safe? A Single Center's Experience.

Although a transradial angiography is accepted as the gold standard for cardiovascular procedures, cerebral angiography has been performed via transfemoral approach in most institutions. The purpose of this study is to present our experience concerning the feasibility, efficacy, and safety of a transradial approach to cerebral angiography as an alternative to a transfemoral approach. Between February 2007 and October 2009, a total of 1,240 cerebral angiographies were performed via a transradial approach in a single center. The right radial approach was used as an initial access route. The procedure continued only after the ulnar artery was proven to provide satisfactory collateral perfusion according to two tests (a modified Allen's test and forearm angiography). The procedural success rate was 94.8% with a mean duration of 28 minutes. All supra-aortic vessels were successfully catheterized with a success rate of 100%. The success rates of selective catheterization to the right vertebral artery, right internal carotid artery, left internal carotid artery, and left vertebral artery were 96.1%, 98.6%, 82.6% and 52.2%, respectively. The procedure was performed more than twice in 73 patients (5.9%), including up to 4 times in 2 patients. The radial artery occlusion was found in 4 patients (5.4%) on follow-up cerebral angiography, but no ischemic symptoms were observed in any of the cases. This study suggests that cerebral angiography using a transradial approach can be performed with minimal risk of morbidity. In particular, this procedure might be useful for follow-up angiographies and place less stress on patients.

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

ObjectiveWe 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 MethodsThirty-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.ResultsThe 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.ConclusionTransradial 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.

Routine transradial access for conventional cerebral angiography: a single operator's experience of its feasibility and safety.

The purpose of this study is to describe a single operator's experience with the feasibility and safety of transradial access in conventional cerebral angiography. 153 patients were enrolled consecutively. Among them, 20 patients were not suitable for transradial access. A Simmons catheter was used. Haemostasis was achieved using a compressive dressing of the wrist. We analysed the success rates of the arterial puncture and the successful catheterization rate for each supra-aortic vessel as well as all complications. The arterial access was successful in 96.3%. The supra-aortic vessels were catheterized with success rates of 99.2% (127/128) for the left subclavian artery and 100% for the other arteries. The mean procedure time was 19.3 min (range 10-55 min). Haemostasis was successfully achieved in every case. The most frequent complication was arm pain which occurred in 37 patients (28.9%). In conclusion, transradial selective cerebral angiography with a reversed-angle catheter is technically feasible and safe. It might be helpful in imaging follow-up of patients with arterial stenting or coil embolisation of the cerebral aneurysms. Modification of the catheter design is required to improve the selectivity of the supra-aortic branches.

Transradial Cerebral Angiography: An Alternative Route

The transradial approach has been well described for arteriography of the coronary vessels. To assess the safety and success rate of the transradial approach for three-vessel or four-vessel diagnostic cerebral arteriography, we reviewed the experience at our institution and compared our complication rates with those found in the literature for transfemoral cerebral angiography and transradial coronary angiography. We reviewed the electronic medical records of 129 consecutive patients in whom 132 cerebral angiographic studies were performed by use of a transradial approach between December 1999 and June 2001. A total of 54 selective catheterizations were performed, of which 39 were of the vertebral artery, 11 of the internal carotid artery, and 4 of the external carotid artery. Records were reviewed for periprocedural and delayed complications, indications for diagnostic angiography, and requirement of conversion to a femoral approach. Records were reviewed prospectively for the first 55 procedures and retrospectively for the next 77 procedures. The mean time to initial clinical follow-up was 1.5 months (median, 0.5 mo). The combined rate of periprocedural and delayed complications was 9%, and there were no major complications. Minor periprocedural complications included transient radial artery spasm (four patients), failure to access the brachial artery (two patients), severe pain (one patient), skin desquamation (one patient), and hematoma (one patient). There were no major complications. At the time of follow-up evaluation, these patients were without deficits related to cannulation of the radial artery. The transradial approach for cerebral angiography is a safe alternative to the transfemoral route. After transradial cerebral angiography, patients require a shorter observation period and are not restricted to bed rest. As technological developments generate smaller, more pliable endovascular surgical devices, future endovascular surgery may be performed transradially.