Authors (including presenting author) :
Liu SH (1), Fung KH (1), Chan NL (2), Ko WS (1), Chau CSK (3), Sham JK (2), Ng JC (1), Chan VWT (1), Mahboobani NR (1), Shek KW (1), Lo JWT (3), Poon TL (2), Fok KF (2), Poon WL (1)
Affiliation :
(1) Department of Radiology and Imaging, Queen Elizabeth Hospital (2) Department of Neurosurgery, Queen Elizabeth Hospital (3) Department of Medicine, Queen Elizabeth Hospital
Introduction :
Transradial approach has evolved as the preferred route of arterial access in percutaneous coronary angiography and interventions. Transradial access is not widely adopted in neuroangiography and neurointerventions.
Objectives :
To review the benefits and limitations of transradial access for neuroangiography and neurointerventions in a single neuroendovascular centre in Hong Kong where diagnostic and treatment approach is transitioning from conventional transfemoral to transradial approach.
Methodology :
Retrospective review of all patients managed with transradial approach for diagnostic neuroangiography and neurointerventions from July 2017 till December 2020. Clinical indication, patient demographics, technical success, clinical outcomes and complications are reviewed.
Result & Outcome :
A total of 51 transradial diagnostic neuroangiography and neurointerventions were done between July 2017 and December 2020. There were 14 diagnostic neuroangiography cases and 37 intervention cases. Out of the 51 procedures, 40 of these including all 14 elective diagnostic neuroangiography procedures were done after July 2020. Prior to July 2020, transradial approach was only adopted when conventional transfemoral approach had failed or was technically difficult. Since July 2020, our neuroendovascular team actively adopted transradial approach for diagnostic neuroangiography and neurointerventions as part of a transition to employ transradial approach as the preferred route of vascular access. Techinical success rate with transradial approach was 98%. Early ambulation of patients could be achieved with transradial approach - in particular, more than half (57.1%) of patients who underwent elective diagnostic neuroangiography could be discharged on the same day as opposed to conventional practice of monitoring overnight for potential bleeding complications in patients who underwent procedures transfemorally. One patient (2%) who underwent an intervention procedure had minor access site-related complication of right arm bruise which resolved spontaneously.
Transradial approach is not widely adopted in neuroangiography and neurointerventions. Our team is actively transitioning to employ transradial approach as the preferred route of vascular access in these procedures.
Transradial approach has high technical success rate, is safe and effective. It has additional benefits of early ambulation and discharge when compared with transfemoral approach. These are essential in the era of COVID-19 to minimise duration of hospital stay and thus risk of cross-infection. It also renders economic benefits in a public healthcare system in terms of bed occupancy.
