Predictors of Transradial Failure in Neurointerventional Procedures

ABSTRACT

INTRODUCTION Neurointerventional procedures have traditionally been performed via transfemoral access. However, according to interventional cardiology literature, transradial access can have decreased access site complications and possibly decreased mortality compared to transfemoral access. Reported limitations for wide adoption of transradial access in neurointerventional procedures include the learning curve. METHODS All neurointerventional procedures performed at a single institution with a transradial first approach were identified from Aug 2017 to January 2020. Demographic and clinical information were identified. Access site complications were recorded. Univariate analysis was performed to identify predictors of transradial failure. Covariates with P < .15 were inputted into a multivariate model with statistical significance set at P < .05. RESULTS A total of 350 transradial neurointerventional procedures were performed in 313 patients. The mean age was 68.2 years and 51% female. Most procedures (95%) used 6F radial sheaths for access. Biaxial system (e.g. microcatheter and microwire) was used in most procedures (61%). There were 81 aneurysm interventions, 73 embolization procedures, 69 angioplasty/stenting procedures, 116 mechanical thrombectomies including 93 involving the anterior circulation, and 11 vasospasm treatments. There was a remarkably high procedure completion rate with a transradial approach (96%, 335/350). Thirteen procedures were converted to transfemoral access (3.7%), 1 procedure converted to transbrachial access, and 1 procedure aborted completely. On multivariate analysis, decreasing age, female gender, and left-sided target artery were predictive of transradial failure. Radial access site complications were extremely rare (0.6%, 2/350 - 1 forearm hematoma, 1 radial artery occlusion). CONCLUSION In a high-volume endovascular center, transradial approach to a wide variety of neurointerventional procedures is both safe and feasible. Predictors of transradial failure include decreasing age, female gender, and left-sided target artery.