Transradial Access: A Feasible and Safe Approach to Neuroendovascular Procedures

Abstract

Introduction—Transradial access is an alternative approach to transfemoral access for most neuroendo‐
vascular procedures. Herein, we report a single-center experience of consecutive diverse cases utilizing a
transradial approach (traditional and anatomical snuffbox). We also report the use of large bore guide cathe‐
ters as long sheaths via a transradial approach.
Methods—A retrospective single-center review of all neuroendovascular procedures from 2015 to 2019
was carried out for cases of the transradial approach.
Results—Twenty-seven cases were identified. Traditional radial access using short sheath was performed
carried out in 12 /27 (44%) cases, up-sized to large bore long sheath in 11/27 (40%) cases, and anatomical
snuffbox (ASB) radial access was performed carried out in 4/27 (16%) cases. A wide variety of procedures
were conducted, with more than a third being diagnostic angiograms and the rest were interventional proce‐
dures. The most common indications for transradial access were aortic arch/vessel tortuosity in 52% and
body habitus in 26% patients. One patient had retention of a large bore catheter leading to the compartment
syndrome.
Conclusion—For selected patients with difficult femoral access or anatomy, the transradial approach is a
safe and feasible alternative route of access. Transradial access via the anatomical snuffbox is also feasible
for neurointerventional procedures, ergonomical, and preferred by patients. We also demonstrated that a
wide spectrum of neurointerventional cases could be safely carried outperformed via a radial approach,
including the transradial use of large bore sheaths like the 6Fr 088 Neuron Max and 6Fr 091 AXS Infinity.
These findings may warrant consideration as a standard method of access in neuroendovascular procedures.