First case series of the transradial approach for neurointerventional procedures in pediatric patients

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OBJECTIVE

The transradial approach (TRA) has been widely adopted by interventional cardiologists but is only now being accepted by neurointerventionalists. The benefits of the TRA over the traditional transfemoral approach (TFA) include reduced risk of adverse clinical events and faster recovery. The authors assessed the safety and feasibility of the TRA for neurointerventional cases in the pediatric population.

METHODS

Pediatric patients undergoing cerebrovascular interventions since implementation of the TRA at the authors’ institution were retrospectively reviewed. Pertinent patient information, procedure indications, vessels catheterized, fluoroscopy time, and complications were reviewed.

RESULTS

There were 4 patients in this case series, and their ages ranged from 13 to 15 years. Each patient tolerated the procedure performed using the TRA without any postprocedural issues, and only 1 patient experienced radial artery spasm, which resolved with the administration of intraarterial verapamil. None of the patients required conversion to the TFA.

CONCLUSIONS

The TRA can be considered a safe alternative to the TFA for neurointerventional procedures in the pediatric population and provides potential advantages. However, as pediatric patients require special consideration due to their smaller-caliber arteries, routine use of ultrasound guidance is advised when attempting the TRA.

ABBREVIATIONS TFA = transfemoral approach; TRA = transradial approach.
Article Information

Contributor Notes

Correspondence Priyank Khandelwal: Rutgers New Jersey Medical School, Newark, NJ. pk544@njms.rutgers.edu.INCLUDE WHEN CITING Published online January 31, 2020; DOI: 10.3171/2019.12.PEDS19448.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Bertrand OFBélisle PJoyal DCosterousse ORao SVJolly SS: Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J 163:6326482012

    • Search Google Scholar
    • Export Citation
  • 2

    Caputo RPTremmel JARao SGilchrist ICPyne CPancholy S: Transradial arterial access for coronary and peripheral procedures: executive summary by the Transradial Committee of the SCAI. Catheter Cardiovasc Interv 78:8238392011

    • Search Google Scholar
    • Export Citation
  • 3

    Chase AJFretz EBWarburton WPKlinke WPCarere RGPi D: Association of the arterial access site at angioplasty with transfusion and mortality: the M.O.R.T.A.L study (Mortality benefit Of Reduced Transfusion after percutaneous coronary intervention via the Arm or Leg). Heart 94:101910252008

    • Search Google Scholar
    • Export Citation
  • 4

    Chen SHSnelling BMShah SSSur SBrunet MCStarke RM: Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study. J Neurointerv Surg 11:7968002019

    • Search Google Scholar
    • Export Citation
  • 5

    Goland JDoroszuk GFGarbugino SLYpa MP: Transradial approach to treating endovascular cerebral aneurysms: case series and technical note. Surg Neurol Int 8:732017

    • Search Google Scholar
    • Export Citation
  • 6

    Hamon MPristipino CDi Mario CNolan JLudwig JTubaro M: Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology. EuroIntervention 8:124212512013

    • Search Google Scholar
    • Export Citation
  • 7

    Irving CZaman AKirk R: Transradial coronary angiography in children and adolescents. Pediatr Cardiol 30:108910932009

  • 8

    Ishii SShime NShibasaki MSawa T: Ultrasound-guided radial artery catheterization in infants and small children. Pediatr Crit Care Med 14:4714732013

    • Search Google Scholar
    • Export Citation
  • 9

    Jolly SSAmlani SHamon MYusuf SMehta SR: Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J 157:1321402009

    • Search Google Scholar
    • Export Citation
  • 10

    Jolly SSYusuf SCairns JNiemelä KXavier DWidimsky P: Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 377:140914202011

    • Search Google Scholar
    • Export Citation
  • 11

    Kolkailah AAAlreshq RSMuhammed AMZahran MEAnas El-Wegoud MNabhan AF: Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev 4:CD0123182018

    • Search Google Scholar
    • Export Citation
  • 12

    Lawson MFVelat GJFargen KMHoh BLMocco J: Direct radial artery access with the 070 neuron guide catheter for aneurysm coiling: a novel application of the neuron catheter for cerebral interventions. Neurosurgery 71 (2 Suppl Operative):E329E3342012

    • Search Google Scholar
    • Export Citation
  • 13

    Levy EIBoulos ASFessler RDBendok BRRinger AJKim SH: Transradial cerebral angiography: an alternative route. Neurosurgery 51:3353422002

    • Search Google Scholar
    • Export Citation
  • 14

    Mann JT IIICubeddu MGSchneider JEArrowood M: Right radial access for PTCA: a prospective study demonstrates reduced complications and hospital charges. J Invasive Cardiol 8 (Suppl D):40D44D1996

    • Search Google Scholar
    • Export Citation
  • 15

    Mason PJShah BTamis-Holland JEBittl JACohen MGSafirstein J: An update on radial artery access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: a scientific statement from the American Heart Association. Circ Cardiovasc Interv 11:e0000352018

    • Search Google Scholar
    • Export Citation
  • 16

    Matsumoto YHongo KToriyama TNagashima HKobayashi S: Transradial approach for diagnostic selective cerebral angiography: results of a consecutive series of 166 cases. AJNR Am J Neuroradiol 22:7047082001

    • Search Google Scholar
    • Export Citation
  • 17

    McCarthy DChen SBrunet MCShah SPeterson EStarke RM: Distal radial artery access in the anatomical snuffbox for neurointerventions: case report. World Neurosurg 122:3553592019

    • Search Google Scholar
    • Export Citation
  • 18

    Mitchell MDHong JALee BYUmscheid CABartsch SMDon CW: Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention. Circ Cardiovasc Qual Outcomes 5:4544622012

    • Search Google Scholar
    • Export Citation
  • 19

    Saito SIkei HHosokawa GTanaka S: Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention. Catheter Cardiovasc Interv 46:1731781999

    • Search Google Scholar
    • Export Citation
  • 20

    Schwemmer UArzet HATrautner HRauch SRoewer NGreim CA: Ultrasound-guided arterial cannulation in infants improves success rate. Eur J Anaesthesiol 23:4764802006

    • Search Google Scholar
    • Export Citation
  • 21

    Seto AHRoberts JSAbu-Fadel MSCzak SJLatif FJain SP: Real-time ultrasound guidance facilitates transradial access: RAUST (Radial Artery access with Ultrasound Trial). JACC Cardiovasc Interv 8:2832912015

    • Search Google Scholar
    • Export Citation
  • 22

    Snelling BMSur SShah SSKhandelwal PCaplan JHaniff R: Transradial cerebral angiography: techniques and outcomes. J Neurointerv Surg 10:8748812018

    • Search Google Scholar
    • Export Citation
  • 23

    Ueda KPuangsuvan SHove MABayman EO: Ultrasound visual image-guided vs Doppler auditory-assisted radial artery cannulation in infants and small children by non-expert anaesthesiologists: a randomized prospective study. Br J Anaesth 110:2812862013

    • Search Google Scholar
    • Export Citation
  • 24

    Valgimigli MGagnor ACalabró PFrigoli ELeonardi SZaro T: Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 385:246524762015

    • Search Google Scholar
    • Export Citation
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