Feasibility and Utility of Transradial Cerebral Angiograpy: Experience during the Learning Period

Objective: We wanted to present our experiences for performing transradial cerebral angiography during the learning period, and we also wanted to demonstrate this procedure's technical feasibility and utility in various clinical situations. Materials and Methods:Thirty-two patients were enrolled in the study.All of them had unfavorable situations for performing transfemoral angiography, i.e., IV lines in the bilateral femoral vein, a phobia for groin puncture, decreased blood platelet counts, large hematoma or bruise, atherosclerosis in the bilateral femoral artery and the insistence of patients for choosing another procedure.After confirming the patency of the ulnar artery with a modified Allen's test and a pulse oximeter, the procedure was done using a 21-G micorpuncture set and 5-F Simon II catheters.After angiography, hemostasis was achieved with 1 2 minutes of manual compression and the subsequent application of a hospital-made wrist brace for two hours.The technical feasiblity and procedure-related immediate and delayed complications were evaluated.Results: The procedure was successful in 30/32 patients (93.8%).Failure occurred in two patients; one patient had hypoplasia of the radial artery and one patient had vasospasm following multiple puncture trials for the radial artery.Transradial cerebral angiography was technically feasible without significant difficulties even though it was tried during the learning period.Pain in the forearm or arm developed in some patients during the procedures, but this was usually mild and transient.Procedure-related immediate complications included severe bruising in one patient and a small hematoma in one patient.Any clinically significant complication or delayed complication such as radial artery occlusion was not demonstrated in our series.Conclusion: Transradial cerebral angiography is a useful alternative for the patients who have unfavorable clinical situations or contraindications for performing transfemoral cerebral angiography.For the experienced neurointerventionalists, it seems that additional training for perfoming transradial cerebral angiography is not needed.he femoral artery has been the most common and popular puncture route for catheter-based cerebral angiography.It is easy to puncture and has an adequate size to insert a catheter or an introducer sheath with a large diameter.The incidence of puncture-related complication is also low if the patients' bleeding profiles are normal and post-angiographic compression is appropriately done.However, the transfemoral approach requires a long procedural time, at least 6 8 hours along with bed rest, and the patients have to be hospitalized for safety.The brachial or axillary artery can be an alternative access routes, but it is well known that the puncture related complication rate is higher for both these arteries (1, 2).