CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2022; 06(03): 184-189
DOI: 10.1055/s-0041-1737026
Review Article

Access Route for Endovascular Neurointervention - Transfemoral to Transradial: Is it Worth the Effort and are we Ready for the Change?

1   Division of Neuroradiology, Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
,
Vivek Agarwal#
2   Division of Neuro and Vascular Intervention, Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
,
Sameer Vyas
1   Division of Neuroradiology, Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
,
Vivek Gupta
3   Department of Interventional Neuroradiology, Paras Hospital, Panchkula, Haryana, India
› Author Affiliations

Abstract

Transfemoral access for neurointerventions has been a time-tested technique of entering the vascular network of the body and reaching the intended targets. However, it has its own share of shortcomings in the form of long admission times leading to increased costs, patient inconvenience and local (though infrequent) adverse affects. Transradial route has taken the interventional cardiology domain by storm and is staring now at other vascular domains especially neurointervention. It has shown better outcomes than the transfemoral route in many aspects. The current article discusses the vascular access perspectives with an exhaustive overview of the transradial route concerning its historical perspectives, its requirement in the current clinical scenario, the procedure per se including the adverse effects and whether it has the real world charm to displace the transfemoral route into the backseat. Transradial access in neurointervention is here to stay, however it would require training, certain modifications in the standard catheters that one currently uses for cerebral procedures and constant practice by the operator to cross the learning curve and attain a certain level of competence before he becomes comfortable with the technique.

# Chirag Kamal Ahuja and Vivek Agarwal contributed equally to the manuscript and are eligible for joint first authorship.


Financial Support

Nil.


Financial Disclosure

Nil.




Publication History

Article published online:
11 November 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Artico M, Spoletini M, Fumagalli L. et al. Egas Moniz: 90 Years (1927-2017) from Cerebral Angiography. Front Neuroanat 2017; 11: 81
  • 2 Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn 1989; 16 (01) 3-7
  • 3 Matsumoto Y, Hokama M, Nagashima H. et al. Transradial approach for selective cerebral angiography: technical note. Neurol Res 2000; 22 (06) 605-608
  • 4 Haussen DC, Nogueira RG, DeSousa KG. et al. Transradial access in acute ischemic stroke intervention. J Neurointerv Surg 2016; 8 (03) 247-250
  • 5 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 (05) 332-337
  • 6 Fessler RD, Wakhloo AK, Lanzino G, Guterman LR, Hopkins LN. Transradial approach for vertebral artery stenting: technical case report. Neurosurgery 2000; 46 (06) 1524-1527 , discussion 1527–1528
  • 7 Oneissi M, Sweid A, Tjoumakaris S. et al. Access-Site Complications in Transfemoral Neuroendovascular Procedures: A Systematic Review of Incidence Rates and Management Strategies. Oper Neurosurg (Hagerstown 2020; 19 (04) 353-363
  • 8 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 (922) 831-838
  • 9 Levy EI, Boulos AS, Fessler RD. et al. Transradial cerebral angiography: an alternative route. Neurosurgery 2002; 51 (02) 335-340 , discussion 340–342
  • 10 Valgimigli M, Campo G, Penzo C, Tebaldi M, Biscaglia S, Ferrari R. RADAR Investigators. Transradial coronary catheterization and intervention across the whole spectrum of Allen test results. J Am Coll Cardiol 2014; 63 (18) 1833-1841
  • 11 Bertrand OF, Carey PC, Gilchrist IC. Allen or no Allen: that is the question!. J Am Coll Cardiol 2014; 63 (18) 1842-1844
  • 12 Valgimigli M, Frigoli E, Leonardi S. et al. MATRIX Investigators. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial. Lancet 2018; 392 (10150): 835-848
  • 13 Starke RM, Snelling B, Al-Mufti F. Society of NeuroInterventional Surgery. et al. Transarterial and transvenous access for neurointerventional surgery: report of the SNIS Standards and Guidelines Committee. J Neurointerv Surg 2020; 12 (08) 733-741 DOI: 10.1136/neurintsurg-2019-015573.
  • 14 Kherad B, Köhncke C, Spillmann F. et al. Postprocedural radial artery occlusion rate using a sheathless guiding catheter for left ventricular endomyocardial biopsy performed by transradial approach. BMC Cardiovasc Disord 2016; 16 (01) 253-53
  • 15 Rashid M, Kwok CS, Pancholy S. et al. Radial artery occlusion after transradial interventions: a systematic review and meta-analysis. J Am Heart Assoc 2016; 5 (01) e002686
  • 16 Beyer AT, Ng R, Singh A. et al. Topical nitroglycerin and lidocaine to dilate the radial artery prior to transradial cardiac catheterization: a randomized, placebo-controlled, double-blind clinical trial: the PRE-DILATE Study. Int J Cardiol 2013; 168 (03) 2575-2578
  • 17 Ünal S, Açar B, Yayla Ç. et al. Manual heating of the radial artery (Balbay maneuver) to facilitate radial puncture prior to transradial coronary catheterization. Rev Port Cardiol 2017; 36 (06) 409-414
  • 18 McCarthy DJ, Chen SH, Brunet M-C, Shah S, Peterson E, Starke RM. Distal radial artery access in the anatomical snuffbox for neurointerventions: case report. World Neurosurg 2019; 122: 355-359
  • 19 Dahal K, Sharma S, Yousuf A. et al. A comparison of standard versus low dose heparin on access-related complications after coronary angiography through radial access: A meta-analysis of randomized controlled trials. Cardiovasc Revasc Med 2018; 19 (5 Pt B): 575-579
  • 20 Kiemeneij F, Vajifdar BU, Eccleshall SC. Laarman G, Slagboom T, van der Wieken R. Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures. Catheter Cardiovasc Interv 2003; 58 (03) 281-284
  • 21 Horie K, Tada N, Isawa T. et al. A randomised comparison of incidence of radial artery occlusion and symptomatic radial artery spasm associated with elective transradial coronary intervention using 6.5 Fr SheathLess Eaucath Guiding Catheter vs. 6.0 Fr Glidesheath Slender. EuroIntervention 2018; 13 (17) 2018-2025
  • 22 Luo N, Qi W, Tong W. et al. Efficacy and Safety of a Novel Catheter for Transradial Cerebral Angiography. Ann Vasc Surg 2019; 60: 236-245
  • 23 Balaban Y. Effectiveness of a handmade “New Carotid Catheter” in transradial carotid angiography: A comparison with conventional multipurpose catheters. J Interv Cardiol 2018; 31 (01) 94-105
  • 24 Caputo RP, Tremmel JA, Rao S. et al. Transradial arterial access for coronary and peripheral procedures: executive summary by the Transradial Committee of the SCAI. Catheter Cardiovasc Interv 2011; 78 (06) 823-839
  • 25 Bernat I, Bertrand OF, Rokyta R. et al. Efficacy and safety of transient ulnar artery compression to recanalize acute radial artery occlusion after transradial catheterization. Am J Cardiol 2011; 107 (11) 1698-1701
  • 26 Hildick-Smith DJ, Walsh JT, Lowe MD, Shapiro LM, Petch MC. Transradial coronary angiography in patients with contraindications to the femoral approach: an analysis of 500 cases. Catheter Cardiovasc Interv 2004; 61 (01) 60-66
  • 27 Louvard Y, Lefèvre T, Allain A, Morice M. Coronary angiography through the radial or the femoral approach: The CARAFE study. Catheter Cardiovasc Interv 2001; 52 (02) 181-187
  • 28 Brener MI, Bush A, Miller JM, Hasan RK. Influence of radial versus femoral access site on coronary angiography and intervention outcomes: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2017; 90 (07) 1093-1104
  • 29 Layton KF, Kallmes DF, Cloft HJ. The radial artery access site for interventional neuroradiology procedures. AJNR Am J Neuroradiol 2006; 27 (05) 1151-1154
  • 30 Nohara AM, Kallmes DF. Transradial cerebral angiography: technique and outcomes. AJNR Am J Neuroradiol 2003; 24 (06) 1247-1250
  • 31 Lee DG, Lee DH, Shim JH, Suh DC. Feasibility of the transradial or the transbrachial approach in various neurointerventional procedures. Neurointervention 2015; 10 (02) 74-81
  • 32 Snelling BM, Sur S, Shah SS. et al. Transradial cerebral angiography: techniques and outcomes. J Neurointerv Surg 2018; 10 (09) 874-881
  • 33 Cooper CJ, El-Shiekh RA, Cohen DJ. 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
  • 34 Kok MM, Weernink MG, von Birgelen C, Fens A, van der Heijden LC, van Til JA. Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study. Catheter Cardiovasc Interv 2018; 91 (01) 17-24
  • 35 Satti SR, Vance AZ, Golwala SN, Eden T. Patient preference for transradial access over transfemoral access for cerebrovascular procedures. J Vasc Interv Neurol 2017; 9 (04) 1-5