Medical Student Perelman School of Medicine Philadelphia, Pennsylvania, United States
Introduction: The use of the transradial access (TRA) for cerebral intraoperative angiograms (IOA) has grown increasingly popular after multiple interventional cardiology studies demonstrated superior outcomes and patient safety when compared to traditional transfemoral access (TFA). While intraoperative TFA has been well studied, intraoperative TRA is poorly characterized with the largest report to date only including 27 patients. We performed a retrospective single-center analysis of our experience with TRA for IOA.
Methods: Between 04/2019 and 05/2022, 61 TRA with subsequent IOA were performed at our single center. Data on technique, case characteristics, positioning, success rate, and access site complications were collected.
Results: During this period, 219 IOAs were performed at our center. Of these, 147 were done via TFA, 61 were TRA, 8 were trans-ulnar, and 3 were transpopliteal. Of the 61 TRA cases, 1 was converted to TFA due to radial artery spasm to complete the IOA. Of these 61 cases, 41 (67.2%) were intracerebral aneurysms, 10 (16.4%) were AVMs, 4 (6.6%) were dural AVF, 2 (3.3%) were bow hunter syndrome, 1 (1.6%) was moyamoya disease, 1 (1.6%) was SDH, 1 (1.6%) was meningioma, and 1 (1.7%) patient underwent a thromboendarterectomy. Of these patients, 25 (42.7%) were male and 35 (58.3%) were female. Regarding patient positioning, 59 (96.7%) were supine, and 2 (3.3%) were prone. The fluoroscopy times were 12.6 ± 12.7 minutes (mean ± SD) with contrast dose of 68.1 ± 37.9 mL. Most (50, 85.2%) of these TRA IOAs were performed on the right arm, and 8 (13.1%) were performed on the left arm, with 50 (82.0%) performed in the wrist and 10 (16.4%) in the anatomic snuffbox. Five TRA IOAs (8.1%) altered surgical management (i.e. repositioning of aneurysm clips).
Conclusion : TRA IOA is safe, effective, and offers potential to improve workflow, surgeon ergonomics, decrease procedural costs, and improve patient outcomes.
