All that glitters: case presentation and review of radial access complications in neurointervention

Abstract

Radial artery access has experienced increasing adoption and rapid expansion of indications for neurointerventional procedures. This access is an attractive neurointervention route to be considered, with many advantages over the traditional femoral access in terms of ease of vasculature navigation and decreased risk of complications such as significant bleeding. Although a promising technique for neurointerventional procedures, there are inherent and unique considerations as well as potential complications involved. The following case report highlights some of these vital concepts associated with radial artery access, including appropriate patient selection as well as assessment of arterial size in the context of neurointerventional techniques. Early identification of complications such as arterial injury and compartment syndrome, with an emphasis on appropriate draping and inter-procedure monitoring, is discussed as well as approaches for subsequent management. Finally, the issue of radiation safety in this emerging technique is considered. These concepts are critical for the successful use and the continued growth of radial artery access for neurointervention procedures.

Keywords: Radial artery access; compartment syndrome; radial artery occlusion.

Figure 1.

Right radial access. A 6 French short sheath was placed into the right radial artery (black arrow) with subsequent angiography demonstrating conventional anatomy (A) with the radial artery measuring up to 2.2 mm. Advancement of a Ballast 088 80 cm 6 French guiding catheter (white arrow) to the mid subclavian artery (B). Unsuccessful attempt to catherize the right common and internal carotid arteries from the radial access (C). Subsequent removal of the Ballast sheath was met with considerable resistance, resulting in injury of the brachial artery.

Figure 2.

Post procedure multiphase computed tomography angiogram of the right upper extremity. Radial/brachial artery hemorrhage was noted in the arterial phase (A) which increased in size and extent on delayed phase imaging (B) indicating active extravasation. These findings correlated with the marked upper extremity swelling noted clinically.