Preliminary experience of distal transradial approach in the anatomic snuffbox for neurointe-rventional diagnosis and treatment
Objective To explore the preliminary experience of distal radial artery approach(dTRA)in neurointerventional diagnosis and treatment,and to evaluate its safety and feasibility.Methods A retrospective analysis was conducted on the clinical data of 62 patients who underwent neurointerventional diagnosis and treatment with dTRA in the Department of Neurointerventional Surgery,Affiliated Hospital of Binzhou Medical University from January to August 2023.The radial artery diameter was measured by Doppler ultrasound before the procedure.The radial artery was punctured using the modified Seldinger technique,and the 6F radial artery sheath was used to establish access in all cases.Complications and patency of the punctured artery were assessed by Doppler ultrasound 1 day or 30 days after the procedure.The technical success rate of neurointerventional diagnosis and treatment via dTRA(success was defined as good blood ejection from the end of the puncture needle,smooth transmission of the guidewire,and successful placement of the arterial sheath and catheter)and puncture-related complications were observed and documented.Results Preoperative Doppler ultrasound measured the forearm radial artery diameter as 2.3±0.3 mm and the diameter of the distal radial artery as 1.8±0.3 mm.All 62 patients underwent diagnostic cerebrovascular angiography,of which 11 cases(17.7％)underwent interventional treatment during the same procedure.The success rate of neurointerventional treatment via dTRA was 75.8％(47/62),of which 13 cases were transformed to the proximal radial approach(pTRA),and 2 cases were transformed to the transfemoral artery approach.Reasons for failure included repeated puncture failure in 11 cases,sheath insertion failure in 3 cases,and failure to place the left vertebral artery in 1 case due to insufficient proximal catheter support via the right dTRA.The catheterization time was 268.2±142.6 s.Doppler ultrasound 1 day after procedure did not reveal weakened pulse in the forearm or distal radial artery or hand ischemic events,and only one case experienced transitory numbness around the puncture site,which resolved spontaneously.One patient who transformed to pTRA due to failed dTRA puncture developed forearm pain at 30-day postoperative follow-up,and Doppler ultrasound showed mid-distal radial thrombosis.Conclusion Neurointerventional treatment via dTRA is clinically safe and feasible,with few overall complications.However,due to its relatively small diameter and difficulties in puncturing and inserting sheath,a certain learning curve needs to be overcome to improve the success rate of the procedure.
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