Pediatric non-galenic pial arteriovenous fistula's characteristics and outcomes: a systematic review.

INTRODUCTION: Pediatric non-galenic pial arteriovenous fistulas (pAVFs) are rare vascular malformations that are characterized by a pial arterial-venous connection without an intervening capillary bed. Outcomes and treatment strategies for pAVFs are highly individualized, owing to the rarity of the disease and lack of large-scale data guiding optimal treatment approaches. METHODS: We performed a systematic review of pediatric patients (< 18 years at diagnosis) diagnosed with a pAVF by digital subtraction angiogram (DSA). The demographics, treatment modalities, and outcomes were documented for each patient and clinical outcome data was collected. Descriptive information stratified by outcome scores were classified as follows: 1 = excellent (no deficit and full premorbid activity), 2 = good (mild deficit and full premorbid activity), 3 = fair (moderate deficit and impaired activity), 4 = poor (severe deficit and dependent on others), 5 = death. RESULTS: A total of 87 studies involving 231 patients were identified. Median age at diagnosis was 3 years (neonates to 18 years). There was slight male preponderance (55.4%), and 150 subjects (81.1%*) experienced excellent outcomes after treatment. Of the 189 patients treated using endovascular approaches, 80.3% experienced excellent outcomes and of the 15 patients surgically treated subjects 75% had an excellent outcome. The highest rate of excellent outcomes was achieved in patients treated with Onyx (95.2%) and other forms of EvOH (100%). High output heart failure and comorbid vascular lesions tended to result in worse outcomes, with only 54.2% and 68% of subjects experiencing an excellent outcome, respectively. *Outcomes were reported in only 185 patients. CONCLUSION: pAVFs are rare lesions, necessitating aggregation of patient data to inform natural history and optimal treatment strategies. This review summarizes the current literature on pAVF in children, where children presenting with heart failure as a result of high flow through the lesion were less likely to experience an excellent outcome. Prospective, large-scale studies would further characterize pediatric pAVFs and enable quantitative analysis of outcomes to inform best treatment practices.

Complex management of pulmonary embolism in APLA syndrome: a case study of ECMO and bivalirudin utilization.

We report a case of a 22-year-old female with antiphospholipid antibody (APLA) syndrome who presented with severe dyspnea. Diagnostic imaging confirmed pulmonary embolism (PE), and treatment comprised unfractionated heparin and apixaban. APLA syndrome was diagnosed based on clinical, serological, and radiological findings. During evaluation, the patient developed cardiogenic shock necessitating catheter-directed thrombolysis, followed by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) due to deteriorating condition and suspected heparin-induced thrombocytopenia (HIT). Surgical embolectomy with bivalirudin use followed, and a hybrid veno-arterial-venous (VAV) ECMO setup was implemented. Postoperatively, the patient improved, transitioning to veno-venous (VV) ECMO and eventually ECMO withdrawal. ECMO is a valuable tool for managing complex cardiorespiratory cases like PE. In the context of HIT and APLA syndrome, prompt anticoagulant transition is vital, and bivalirudin is an effective heparin alternative. Our study highlights the challenges involved in managing patients needing ECMO support with immunothrombotic conditions like HIT and APLA syndrome.

Near-IR Capturing N-Methylbenzene Sulfonamide-Phenothiazine Incorporating Strong Electron Acceptor Push-Pull Systems: Photochemical Ultrafast Carrier Dynamics.

Unraveling the intriguing aspects of the intramolecular charge transfer (ICT) phenomenon of multi-modular donor-acceptor-based push-pull systems are of paramount importance considering their promising applications, particularly in solar energy harvesting and light-emitting devices. Herein, a series of symmetrical and unsymmetrical donor-acceptor chromophores 1-6, are designed and synthesized by the Corey-Fuchs reaction via Evano's condition followed by [2+2] cycloaddition retroelectrocyclic ring-opening reaction with strong electron acceptors TCNE and TCNQ in good yields (~60-85 %). The photophysical, electrochemical, and computational studies are investigated to explore the effect of incorporation of strong electron acceptors 1,1,4,4-tetracyanobuta-1,3-diene (TCBD) and dicyanoquinodimethane (DCNQ) with phenothiazine (PTZ) donor. An additional low-lying broad absorption band extended towards the near-infrared (NIR) region suggests charge polarization after the introduction of the electron acceptors in both symmetrical and asymmetrical systems, leading to such strong ICT bands. The electrochemical properties reveal that reduction potentials of 3 and 6 are lower than those of 2 and 5, suggesting DCNQ imparts more on the electronic properties and hence largely contributes to the stabilization of LUMO energy levels than TCBD, in line with theoretical observations. Relative positions of the frontier orbitals on geometry-optimized structures further support accessing donor-acceptor sites responsible for the ICT transitions. Eventually, ultrafast carrier dynamics of the photoinduced species are investigated by femtosecond transient absorption studies to identify their spectral characteristics and target analysis further provides information about different excited states photophysical events including ICT and their associated time profiles. The key findings obtained here related to excited state dynamical processes of these newly synthesized systems are believed to be significant in advancing their prospect of utilization in solar energy conversion and related photonic applications.

A Case of Naevoid Blaschkoid Psoriasis in a Two-Year-Old Child.

Psoriasis is a chronic, immune-mediated skin disorder characterised by well-demarcated erythematous plaque with micaceous scale. Naevoid Blaschkoid psoriasis is an unusual subtype that occurs along Blaschko lines. A two-year-old boy presented with erythematous scaly lesions distributed along the lines of Blaschko over the bilateral upper limb, the front of the chest, back, and the right lower limb. The lesions appeared four months ago and slowly progressed. There was no history of trauma, no skin lesions in other parts of the body, and no significant family history. Nail and mucosa were normal. Histopathology showed psoriasiform dermatitis with characteristics of psoriasis. The child was treated with topical clobetasol propionate 0.05% cream. Naevoid Blaschkoid psoriasis, in the absence of psoriatic lesion elsewhere on the body, is a rare manifestation. It has striking similarity with inflammatory linear verrucous epidermal nevus (ILVEN), both clinically and histologically. Naevoid psoriasis usually presents late, is asymptomatic or mildly pruritic, progresses rapidly, and responds favourably to antipsoriatic treatment. In contrast, ILVEN presents early, is intensely pruritic, slowly progressive, and is usually refractory to antipsoriatic treatment. Histologically, ILVEN demonstrates abruptly alternating areas of hypergranulosis with orthokeratosis, and parakeratosis with agranulosis. An inflammatory infiltrate is present in the upper dermis. Psoriasis presents with papillomatosis, acanthosis, and parakeratosis with absent or minimal granular layer. Immunohistochemical staining can be done in such doubtful cases. Involucrin would be detectable in psoriasis, but it is absent in ILVEN. Pathogenesis of linear psoriasis is unknown but might be explained by the concept of genetic mosaicism. Although rare, there have been a few reported cases of linear psoriasis occurring in early childhood.

Spine Deformity Associated with Chiari I Malformation and Syringomyelia.

The management of scoliosis in patients with Chiari I malformation and syringomyelia is a complex decision-making process, which is changing due to evolving evidence. Headache and scoliosis are common presenting symptoms of an underlying Chiari. History, physical examination, and screening with MRI are cornerstones of diagnosis. Posterior fossa decompression provides curve stabilization or regression in about half of patients. In those who require spinal fusion, careful attention must be paid to intraoperative neurological monitoring data to minimize risk of neurologic injury.

Neurosurgery Applicant Perspective of Neurosurgery Residency Websites.

OBJECTIVE: Applicants rely heavily on virtual information in the form of neurosurgery residency websites (NRWs) to better understand a program's culture, faculty, and opportunities. There is a paucity of information regarding the value of NRW on applicant decision making. The advent of the supplemental ERAS application and continuation of virtual interviews may increase the propensity of which applicants use NRW. The objective of our study was to distribute a survey to further understand applicants' perceptions and opinions of NRW, as well as provide future direction for NRW optimization. METHODS: The current study is a single-institution, retrospective survey design. A survey was designed via Qualtrics software to evaluate applicant demographics, resident education, resident recruitment, and future directions. The survey includes the most frequently used variables on NRW. The survey was distributed to neurosurgery applicants who received an interview at the University of Alabama at Birmingham. Data were analyzed using Microsoft Excel. RESULTS: Among the 293 applicants who received a link to the survey, 87/293 (29.7%) completed it. Respondents elected that useful website variables were "resident rotation schedules and hospital locations," "faculty listings and biographies," and "neurosurgery residency websites served as a first impression of a neurosurgery residency program." More than half of the respondents agreed that their rank list would not be the same without an NRW. The most strongly received statement for future directions was "Neurosurgery residency programs will benefit from renovating their residency website." CONCLUSIONS: Our data suggest NRWs play a vital role in resident recruitment and decision making. Residency programs will benefit from this data and may use it to restructure their virtual recruitment tools and discover innovative virtual recruitment strategies. Our team elucidated the most important variables found on NRWs and proposed future directions for their improvement and the virtual application and recruitment process.

New autopsy technique in COVID-19 positive dead bodies: opening the thoracic cavity with an outlook to reduce aerosol spread.

AIMS: After the advent of the COVID-19 pandemic, most countries have modified some of their health-related regulations. However, this has not been in the case of the postmortem of deceased because it has a legal aspect. Thus, the healthcare providers knowingly or unknowingly faced the threat of COVID-19 exposure from those dead bodies. To introduce an autopsy technique that reduces the droplet spreads, especially in those mortuaries where the biosafety mechanism is not highly equipped. METHODS: The validity of the new incision was achieved through the calculation of the Scale Content Validity Index (SCVI) taking inputs from 17 forensic specialists. The subjects for the new technique were selected from the patients who were RTPCR positive for COVID-19 or clinically or radiologically showing features of COVID-19. RESULTS: The dissection procedure was finalised by achieving the SCVI at 0.92. The chest cavity was approached through the abdominal cavity by opening the diaphragm and dissecting out the contents of the chest using a long blade knife. CONCLUSIONS: The advantage of this approach is that the autopsy surgeon and pathologists do not have to open the chest cavity by dissecting the Sternum, and hence the chance of droplet infection becomes almost nil. This technique is complete, simple, less time-consuming and conducive for sample collection, and even reduces the possibility of body fluid seepage following a postmortem examination.

Macromolecular Crowding Significantly Affects the Conformational Features and Carbohydrate Binding Properties of CIA17, a PP2-Type Lectin from Coccinia indica.

The effect of macromolecular crowding on the conformational features and carbohydrate binding properties of CIA17, a PP2-type lectin, was investigated employing polymeric dextrans D6, D40, and D70 (Mr ∼ 6, 40, and 70 kDa, respectively) as crowders. While the secondary structure of CIA17 was significantly affected by D6, with a considerable decrease in the number of ß-sheets and ß-turns with a corresponding increase in the number of unordered structures, relatively smaller changes were induced by D40 and D70. However, differential scanning calorimetry (DSC) studies revealed that the thermal stability of the protein remains unchanged in the presence of crowders. While the larger dextrans, D70 and D40, induced modest quenching (∼10%) of the protein fluorescence by a static pathway, the smaller D6 induced a higher degree of quenching (37%), which involved both static and collisional quenching processes. The results of fluorescence correlation spectroscopy measurements together with DSC studies suggested that CIA17 forms larger oligomers in the presence of D40 and D70 but D6 prevents the formation of higher-order oligomers. The association constant for the CIA17-chitooligosaccharide interaction increased by ∼30% and 160% in the presence of D40 and D70, respectively, but decreased by ∼30% in the presence of D6. The higher binding affinity can be attributed to the excluded volume effect, i.e., an increased effective concentration of the protein in the presence of D40 and D70, whereas D6, being smaller, possibly penetrates into the protein interior, disrupting the water structure around the protein and also inducing conformational changes, resulting in weaker binding. These observations demonstrate that molecular crowding significantly affects the carbohydrate binding characteristics of lectins, which can modulate their physiological function.

Management of Cerebral Herniation Secondary to Lead Encephalopathy: A Case Report.

Background: Adult lead encephalopathy is a rare but critical condition to recognize in modern healthcare settings. Few reports have described the medical and neurosurgical management of severe adult lead encephalopathy. Case Presentation: A 22 year old woman presented with severe headache, anemia, vomiting, 40-lb weight loss, and constipation. At the time of presentation, she had extensive colonic radiopaque material and a serum lead concentration of 87 mcg/dl (normal <10). She rapidly developed anisocoria requiring emergent ventriculostomy insertion. Following CSF diversion, ICP mitigation, and lead chelation, she considerably improved in <2 weeks. Conclusion: We report one of the few instances of successful surgical and medical management of adult lead encephalopathy. Dedicated neurocritical care and neurosurgical teams are necessary in conjunction with toxicology in order to manage the advanced sequalae of severe lead poisoning.

On direct synthesis of high quality APbX3 (A = Cs+, MA+ and FA+; X = Cl-, Br- and I-) nanocrystals following a generic approach.

Direct synthesis of APbX3 [A = Cs+, methylammonium (MA+) or formamidinium (FA+) and X = Cl-, Br- or I-] perovskite nanocrystals (NCs) following a generic approach is a challenging task even today. Motivated by our recent success in obtaining directly high-quality red/NIR-emitting APbI3 NCs employing 1,3-diiodo-5,5-dimethylhydantoin (DIDMH) as an iodide precursor, we explore here whether violet/green-emitting APbCl3 and APbBr3 NCs can also be obtained using the chloro- and bromo-analog of DIDMH keeping in mind that a positive outcome will provide the generic protocol for direct synthesis of all APbX3 NCs using similar halide precursors. It is shown that green-emitting APbBr3 NCs with near-unity PLQY and violet-emitting CsPbCl3 NCs with an impressive PLQY of ∼70%, mixed-halide NCs, CsPb(Cl/Br)3 and CsPb(Br/I)3, emitting in the blue and yellow-orange region with PLQYs of 87-95% and 68-98%, respectively can indeed be obtained employing the bromo- and chloro-analog of DIDMH. These NCs exhibit remarkable stability under different conditions including the polar environment. Femtosecond pump-probe studies show no ultrafast carrier trapping in these systems. The key elements of the halide precursors that facilitated the synthesis and the factors contributing to the excellent characteristics of the NCs are determined by careful analysis of the data. The results are of great significance because a direct method of obtaining highly luminescent and stable APbX3 NCs (except violet-emitting hybrid NCs) is eventually identified and the work provides valuable insight into the selection of appropriate halide precursors for the development of superior systems.

Low-pH Molten Globule-Like Form of CIA17, a Chitooligosaccharide-Specific Lectin from the Phloem Exudate of Coccinia indica, Retains Carbohydrate-Binding Ability.

pH-induced changes in the conformation, structural dynamics, and carbohydrate-binding activity of Coccinia indica agglutinin (CIA17), a PP2-type lectin, were investigated employing biophysical approaches. The secondary structure of CIA17 remains nearly unaltered over a wide pH range (2.0-8.5), while the tertiary structure of the protein exhibits considerable changes. A decrease in the fluorescence intensity and excited-state lifetime at low pH indicated perturbation in the local conformation (near Trp residues) of CIA17, which was further supported by enhancement in the Trp accessibility toward charged quenchers under acidic conditions. Fluorescence correlation spectroscopic studies indicated that at pH 2.0, CIA17 exists as a monomer over the concentration range of 10-200 nM and forms dimers at higher concentrations (KD ∼ 387 nM) but could not form higher oligomers even at ∼150-fold higher concentrations, unlike under native conditions at pH 7.4. Thermal unfolding of the low pH intermediate involves two distinct steps: dissociation of a dimer to a monomer, followed by the unfolding of the monomer. These results strongly suggest that the acid-induced unfolding pathway of CIA17 involves the formation of a monomeric molten globule-like intermediate, which retains appreciable carbohydrate-binding ability. These observations are of great physiological significance since the PP2 proteins are involved in plant defense responses.

Could It be Wolf Isotopic Response?: Occurrence of Dermatophytoses on Vitiliginous Skin-Case Series of Five Cases from a Tertiary Care Centre in India.

Wolf isotopic response is the occurrence of new dermatoses on areas of the skin with previous but still active dermatoses. Vitiligo is an acquired disorder characterized by the loss of functional melanocytes which manifests as circumscribed depigmented macules and patches. Dermatophytoses are superficial fungal infections caused by three genera of fungi (Microsporum, Trichophyton, and Epidermophyton) that have the unique ability to invade and multiply within keratinized tissue (skin, hair, and nail). The appearance of dermatophyte infection on previously present vitiligo lesion is an uncommon example of Wolf response. We describe a case series of five vitiligo patients that presented to our OPD over 1 year period.

Disseminated violaceous plaques in a HIV-1-positive patient from eastern India: A manifestation of Kaposi's sarcoma.

Kaposi's sarcoma (KS) is an angioproliferative disorder primarily of viral etiology, though multiple cofactors are also responsible. Human herpes virus-8, a gamma herpes virus, is considered to be the causative agent. Acquired immunodeficiency syndrome-associated KS has different clinical pictures than those seen in other types of KS. As it progresses rapidly, early institution of highly active antiretroviral therapy (HAART) after proper diagnosis is expected. Though HAART has reduced the prevalence of KS in HIV disease, HAART has not eliminated the disease. Here, we report a case who is HIV 1 and hepatitis B surface antigen positive with numerous violaceous plaques over the face, upper extremities, and trunk along with oral mucosal involvement. He had received ten sessions of electron beam radiotherapy on the face, and the facial lesions have healed with residual hyperpigmentation.

Moxifloxacin-induced oral erythema multiforme: An unusual adverse effect hitherto unreported.

Moxifloxacin is a fluoroquinolone with excellent activity in community-acquired respiratory tract infections. Common adverse effects are gastrointestinal symptoms, headache, dizziness, etc., Some serious adverse effects include tendon rupture, rhabdomyolysis, peripheral neuropathy, and interstitial nephritis. Cutaneous adverse effects include allergic reactions, angioedema, Steven-Johnson syndrome, and toxic epidermal necrosis. Erythema multiforme (EM), an acute self-limiting disease, most commonly occurs due to infection and rarely due to drugs or systemic disease. EM is classified into EM major and minor, both having skin lesions. A third category of EM has also been described with only oral involvement and without any skin lesions. Oral EM itself is an uncommon entity which has been reported due to nonsteroidal anti-inflammatory drugs. Here, we are reporting a case of moxifloxacin-induced oral EM. After extensive search in PubMed-Medline database, we could not find any such co-occurrence of moxifloxacin-induced oral EM. To the best of our knowledge, this is the first reported case.

Validation and comparison of analytical methods for the determination of uric acid in pulses and cereals by salting out assisted extraction by Rapid resolution liquid chromatography.

An analytical method was developed and validated for the quantitative determination of uric acid in cereals and pulses based on salting-out assisted extraction and subsequent analysis by Rapid Resolution Liquid Chromatography (RRLC). Uric acid is a degradation product of purines, which is an indicator of insect infestation and the state of stored grains and pulses. This study aims to compare and validate a high-performance liquid chromatography method with Diode-array detection (HPLC-DAD) and fluorescence detection (HPLC-FLD) for the estimation of uric acid. Protein precipitation with ammonium sulfate and acetonitrile was used for sample cleanup and pre-treatment. The addition of inorganic ions results in preferential solvation and precipitates proteins. The separation was performed on a Zorbax SB C18 column (150 × 4.6 mm, 5 µm) with an isocratic elution using water-acetonitrile containing 10 mM sodium dihydrogen phosphate (95:5, v/v), at a flow rate of 0.5 mL/min. The relative coefficient (r2) for the calibration curve was more than 0.995 over the concentration range of 25-200 mg/kg. This method's precision at concentrations of 25-150 mg/kg was within 7.25%, and the accuracy was 85.1%-92.7%. The method was validated in terms of the LOD, LOQ, repeatability, reproducibility, linearity, uncertainty, specificity & system suitability. The limit of detection and limit of quantification was 16.60 mg/kg and 50.34 mg/kg, respectively.

Lessons Learned After 760 Neurointerventions via the Upper Extremity Vasculature: Pearls and Pitfalls.

BACKGROUND: The radial approach has been gaining more widespread use by neurointerventionalists fueled by data from the cardiology literature showing better safety and overall reduced morbidity. OBJECTIVE: To present our institution's experience with the radial approach for neuroendovascular interventions in 614 consecutive patients who underwent a cumulative of 760 procedures. METHODS: A retrospective analysis was performed and identified neuroendovascular procedures performed via the upper extremity vasculature access site. RESULTS: Amongst 760 procedures, 34.2% (260) were therapeutic, and 65.7% (500) were nontherapeutic angiograms. Access sites were 71.5% (544) via a conventional radial artery, 27.8% (211) via a distal radial artery, 0.5% (4) via an ulnar artery, and 0.1% (1) via the brachial artery. Most of the procedures (96.9%) were performed via the right-sided (737), 2.9% (22) via the left-sided, and 0.1% (1) via a bilateral approach. Major access site complications occurred at a rate of 0.9% (7). The rate of transfemoral conversion was 4.7% (36). There was a statistically higher incidence of transfemoral conversion when repeat procedures were performed using the same access site. Also, there was no significant difference between nontherapeutic procedures performed using the right and left radial access, and conventional versus distal radial access. Procedural metrics improved after completion of 14 procedures, indicating a learning curve that should be surpassed by operators to reach optimal outcomes. CONCLUSION: Radial artery catheterization is a safe and effective means of carrying out a wide range of neuroendovascular procedures associated with excellent clinical outcomes and an overall low rate of periprocedural complications.

Phenylalanine-Tethered pH-Responsive Poly(2-Hydroxyethyl Methacrylate).

A series of pH-responsive random copolymers comprised of 2-hydroxyethyl methacrylate (HEMA) and tert-butyl carbamate (Boc)-protected phenylalanine methacryloyloxyethyl ester (Boc-Phe-EMA) were synthesized via reversible addition-fragmentation chain transfer (RAFT) polymerization in N,N'-dimethylformamide (DMF) at 70 °C. The synthesized copolymers were comprehensively characterized using a combination of techniques, including 1 H NMR, FT-IR spectroscopy and size exclusion chromatography (SEC). Reactivity of each monomers towards controlled radical polymerization was evaluated by determining the reactivity ratios by virtue of extended Kelen-Tüdös method at high conversions revealed the higher reactivity of non-modified HEMA (rHEMA =1.03) in contrast to Boc-Phe-EMA (rBoc-Phe-EMA =0.48). Furthermore, the expulsion of the Boc-groups resulted copolymers with ionizable pendant primary ammonium and hydroxyl groups. To understand the glass transition behaviours of homo- and co-polymers, differential scanning calorimetric (DSC) measurements were carried out. The effect of HEMA content on the pH-sensitivity of the copolymers in aqueous medium was investigated through turbidity measurements. Finally, the counteranion exchange from trifluoroacetate to chloride provided copolymers with enhanced water solubility and unaltered phase transition pH.

Capturing Initial Understanding and Impressions of Surgical Therapy for Parkinson's Disease.

Background: Deep Brain Stimulation (DBS) is an underutilized surgical therapy for Parkinson's Disease (PD). Both physician and patient hesitancies have been described as potential barriers to DBS, but the specifics of patient perceptions of DBS have not been well-characterized in the general PD population. Objective: To characterize the understanding and impressions of surgical therapy in PD patients prior to formal surgical evaluation. Methods: A 30-question survey assessing impressions of surgical therapy for PD and understanding of DBS for PD was administered to PD patients seen at an urban movement disorders clinic. Results: One hundred and two patients completed the survey. When asked if they would undergo a hypothetical risk-free, curative brain surgery for PD, 98 patients responded "yes." Patients were more agreeable to "reversible," "minimally-invasive," and "incisionless" surgery. 51.2% thought DBS is an "effective" treatment for PD, 76.6% thought it was "invasive," and 18.3% thought it was "reversible." 45.2% reported fear of being awake during DBS surgery. Regarding costs, 52.4% were concerned that DBS was "very expensive" or "not covered by insurance." Initial source of information and perceived treatment effectiveness were not associated with concerns about DBS effectiveness or threats to normality. Negative perceptions of past surgery were associated with concerns about DBS altering mood and personality. Conclusion: Overall, patients expressed concerns regarding procedural efficacy, invasiveness, cost, and irreversibility-independent of the original source of information. Future studies are required to allow us to better understand the impact of these initial findings on DBS hesitancy and underutilization.

Adoption of the Transradial Approach for Neurointerventions: A National Survey of Current Practitioners.

OBJECTIVES: The transradial approach (TRA) is technically feasible for both diagnostic and therapeutic neurointerventions. It improves patient comfort and is not associated with increased procedural complications when compared to the transfemoral approach (TFA). To date, no studies have looked at barriers to adoption of TRA in the neurointerventionalist community. This study aims to obtain neurointerventionalist perspectives on their adoption of TRA. MATERIALS AND METHODS: Online survey distributed to neurointerventionalists. RESULTS: A total of 55 neurointerventionalists, 52 of whom utilized TRA, responded to our survey. Overall, participants were not concerned about TRA's technical feasibility for diagnostic or therapeutic neurointerventions or about procedural complications. Most of our cohort adopted TRA due to its increased patient comfort and to reduce access site complications. In-institution interventionalists were strongly perceived to be the most effective method of teaching TRA when compared to other methods. Catheters and equipment issues were reported by about 30% of our cohort as a barrier to TRA adoption. CONCLUSIONS: The neurointerventionalist community largely perceives TRA to be technically feasible and was not concerned about its procedural complications. In-person institutionalists are strongly perceived to be the most effective method of teaching the approach. A significant barrier to adoption seems to be related to catheters and equipment issues.