Abstract
Abstract
INTRODUCTION:
Widely adopted by interventional cardiology, radial access has seen slower adoption in neurointerventional procedures despite its proven increased safety and patient satisfaction. Based on our positive initial experience with radial access, as well as increased patient satisfaction, we adopted a “radial first” policy for diagnostic angiography. We present our initial experience transitioning from the traditional transfemoral approach to a radial-first approach.
METHODS:
Procedural data were reviewed from 103 consecutive transradial diagnostic cerebral angiograms performed between November 2015 and February 2016. Standard data related to patient safety and procedural metrics were recorded. Learning curve was assessed by comparing mean vessel catheterization time (minutes fluoroscopy time per vessel) between the first and last 10 procedures involving at least 3 vessels. All patients were discharged 90 minutes after closure, and, as is standard at our institution, all were contacted by phone 24 hours later.
RESULTS:
The right radial artery was successfully catheterized in 100% of patients. The preplanned great vessels of interest were successfully catheterized in 98% of patients. There was 1 minor complication (persistent forearm pain treated with oral steroids) and no major complications. Radial artery patency measured by reverse-Barbeau test at discharge was 100%. No cases required conversion to a transfemoral approach. Operators demonstrated a steep learning curve, improving average vessel catheterization time from 4.24 minutes/vessel to 3.22 minutes/vessel. We noted a substantial decrease in access site pain and discomfort complaints on the 24-hour follow-up patient phone interview.
CONCLUSION:
Transradial access offers well documented lower access site complications, improved patient satisfaction, and shorter length of stay. Our initial experience shows this improved safety profile can be achieved without sacrificing procedural time or completeness of the angiogram. As with all new procedures, a learning curve exists for those new to the radial approach.