Radial access for neurointervention: room set-up and technique for diagnostic angiography

Abstract

A number of prospective randomized trials have shown that the radial artery is a safer access site than the femoral artery for endovascular procedures.1–4 In the cardiac literature there was a 60% reduction in access site complications as well as significant decreases in all-cause mortality with the transradial approach compared with the transfemoral approach, which has led to the adoption of a radial first strategy.5–7 The neurointerventional literature has demonstrated similar safety benefits as well as improved patient preference.8–14 However, the technical aspects of how to perform neurointervention via the radial approach are still unknown to the majority of neurointerventionalists. This technical video 1 covers the details of how to perform a diagnostic angiogram via the radial approach. Initially, steps such as pre-procedure preparation, room set-up, and patient positioning are discussed. Following this, puncture techniques and sheath placement are outlined, including the snuffbox technique. The steps of a full six-vessel cerebral angiogram are then shown in detail. Finally, closure techniques are demonstrated.Video 1The image in the opening frame and at 2:24 is reused with permission from Brunet et al, Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography. J Neurointerv Surg 2019;11:710–3. Copyright 2019 BMJ Publishing Group.The other image in the opening frame is reused with permission from Chen et al, Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study. J Neurointerv Surg, 2019;11:796-800. Copyright 2019 BMJ Publishing Group.The images at 0:38 and 8:24 are reused with permission from Snelling et al, Transradial cerebral angiography: techniques and outcomes. J Neurointerv Surg 2018;10:874–81. Copyright 2018 BMJ Publishing Group.