Risk factors for puncture-related complications after cerebrovascular angiography and neuroendovascular intervention with distal transradial approach

Abstract

Background and purpose: To determine the risk factors for puncture-related complications after the distal transradial approach (dTRA) for cerebrovascular angiography and neuroendovascular intervention and to explore the incidence and potential mechanisms of procedural failure and puncture-related complications.

Materials and methods: From February to November 2023, 62 patients underwent dTRA in our department. Demographic, clinical, and procedural data were collected retrospectively. Postoperative puncture-related complications were defined as a syndrome of major hematoma, minor hematoma, arterial spasm/occlusion, arteriovenous fistula, pseudoaneurysm, and neuropathy. Univariate and multivariate logistic regressions were performed to identify significant factors contributing to puncture-related complications.

Results: Forty-five diagnostic cerebral angiograms and 17 neurointerventions were performed or attempted with dTRA in 62 patients. Procedural success was achieved via dTRA in 47 (75.8%) patients, whereas 15 (24.2%) required conversion to other approaches. Reasons for failure included puncture failure (n = 8), inability to cannulate due to arterial spasm (n = 6), and inadequate catheter support of the left vertebral artery (n = 1). 17.0% (8/47) of patients had postoperative puncture-related complications. Minor hematoma occurred in 8.5% (4/47) of patients, arterial spasm/occlusion in 6.3% (3/47), and neuropathy in 2.1% (1/47). No major complications were observed. On stepwise multivariable regression analysis, BMI (OR = 0.70, 95%CI 0.513 to 0.958; p = 0.026) was an independent risk factor for puncture-related complications, with a cut-off of 24.8 kg/m² (sensitivity 66.7% and specificity 87.5%).

Conclusion: Our cohort is the first study of risk factors for puncture-related complications after neurointerventional interventions with dTRA. This study has shown that a low BMI (< 24.8 kg/m²) is independently associated with the development of puncture-related complications.

Keywords: Complications; Diagnostic cerebral angiography; Distal transradial approach; Risk factors.

Fig. 1

Distal radial artery puncture site (anatomical snuffbox area) and relevant surrounding anatomic structures. A Vascular anatomy of the forearm and hand. B

Fig. 2

Preoperative assessments of forearm RA and dRA based on ultrasonography. A Diameter of the RA in the horizontal section. B Diameter of the dRA in the longitudinal section. RA, radial artery; dRA, distal radial artery

Fig. 3

Distal transradial approach technique. A The patient’s right hand is kept in a neutral position on the side-board, and the wrist is elevated using padding with the fingers curled. The entire forearm is sterilized (including the radial and ulnar artery puncture points). B An 18G needle was used to puncture the dRA in a single wall at 30° to 45°, and the blood spray at the tail of the needle was observed. (C, D) After ensuring backflow, a 018″ guidewire and a 6F radial sheath are gently inserted. (E, F) Place a small piece of gauze over the puncture site and roll it tightly with an elastic

Fig. 4

The receiver operating characteristic (ROC) curve. (III) The AUC was 0.72 (95%CI, 0.668 to 0.769). The cut-off baseline value for BMI was set to 24.8 with specificity of 87.5% and sensitivity of 66.7%, respectively