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. 2021 Jun;13(6):552-558.
doi: 10.1136/neurintsurg-2020-016448. Epub 2020 Aug 13.

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

Nickalus R Khan  1   2 , Jeremy Peterson  1   2 , David Dornbos Iii  1   2 , Vincent Nguyen  1   2 , Nitin Goyal  3   4 , Radmehr Torabi  1   2 , Daniel Hoit  1   2 , Lucas Elijovich  3   4 , Violiza Inoa-Acosta  3   4 , David Morris  5 , Christopher Nickele  1   2 , Pascal Jabbour  6 , Eric C Peterson  7 , Adam S Arthur  8   2
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Predicting the degree of difficulty of the trans-radial approach in cerebral angiography

Nickalus R Khan et al. J Neurointerv Surg. 2021 Jun.

Abstract

Background: To evaluate anatomical and clinical factors that make trans-radial cerebral angiography more difficult.

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<0.03). The presence of a large diameter aortic arch (p<0.01), double subclavian innominate curve (p<0.01), left proximal common carotid artery (CCA) loop (p<0.001), acute subclavian vertebral angle (p<0.01), and absence of bovine aortic arch anatomy (p=0.03) were 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, double subclavian innominate curve, proximal left CCA loop, acute subclavian vertebral angle, and absence of bovine aortic arch anatomy were associated with more difficult trans-radial cerebral angiography. We also introduce a novel grading scale for diagnostic trans-radial angiography.

Keywords: CT Angiography; artery; catheter; guidewire.

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Conflict of interest statement

Competing interests: DH serves as a consultant for Covidien/Medtronic and Microvention; and is a shareholder of Cerebrotech, Marblehead Medical, and Silver Bullett. LE serves as a consultant for Balt, Cerenovus, Medtronic, MicroVention, Penumbra, and Stryker. CN has received research support from Microvention. PJ is a consultant for Medtronic and MicroVention. ECP is a consultant for Cerenovus, Medtronic Neurovascular, Penumbra, and Stryker Neurovascular; and is a shareholder of RIST Neurovascular. ASA is a consultant for Johnson and Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, and Stryker; receives research support from Balt, Cerenovus, Medtronic, Microvention, Penumbra, Siemens, and Stryker; and is a shareholder in Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad Medical, and Vascular Simulations.

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