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Implementation of a radial long sheath protocol for radial artery spasm reduces access site conversions in neurointerventions.
Luther, Evan; Chen, Stephanie H; McCarthy, David J; Nada, Ahmed; Heath, Rainya; Berry, Katherine; Strickland, Allison; Burks, Joshua; Silva, Michael; Sur, Samir; Yavagal, Dileep R; Starke, Robert M; Peterson, Eric C.
Afiliação
  • Luther E; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA evan.luther@jhsmiami.org.
  • Chen SH; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
  • McCarthy DJ; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Nada A; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
  • Heath R; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
  • Berry K; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
  • Strickland A; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
  • Burks J; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
  • Silva M; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
  • Sur S; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
  • Yavagal DR; Neurology and Neurosurgery, University of Miami, Miami, Florida, USA.
  • Starke RM; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
  • Peterson EC; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
J Neurointerv Surg ; 2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843358
ABSTRACT

BACKGROUND:

Many neurointerventionalists have transitioned to transradial access (TRA) as the preferred approach for neurointerventions as studies continue to demonstrate fewer access site complications than transfemoral access. However, radial artery spasm (RAS) remains one of the most commonly cited reasons for access site conversions. We discuss the benefits, techniques, and indications for using the long radial sheath in RAS and present our experience after implementing a protocol for routine use.

METHODS:

A retrospective review of all patients undergoing neurointerventions via TRA at our institution from July 2018 to April 2020 was performed. In November 2019, we implemented a long radial sheath protocol to address RAS. Patient demographics, RAS rates, radial artery diameter, and access site conversions were compared before and after the introduction of the protocol.

RESULTS:

747 diagnostic cerebral angiograms and neurointerventional procedures in which TRA was attempted as the primary access site were identified; 247 were performed after the introduction of the long radial sheath protocol. No significant differences in age, gender, procedure type, sheath sizes, and radial artery diameter were seen between the two cohorts. Radial anomalies and small radial diameters were more frequently seen in patients with RAS. Patients with clinically significant RAS more often required access site conversion (p<0.0001), and in our multivariable model use of the long sheath was the only covariate protective against radial failure (OR 0.061, 95% CI 0.007 to 0.517; p=0.0103).

CONCLUSION:

In our experience, we have found that the use of long radial sheaths significantly reduces the need for access site conversions in patients with RAS during cerebral angiography and neurointerventions.
Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Idioma: Inglês Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Estados Unidos

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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Idioma: Inglês Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Estados Unidos
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