J Korean Neurosurg Soc.  2013 Apr;53(4):213-217. 10.3340/jkns.2013.53.4.213.

Efficacy of Transradial Cerebral Angiography in the Elderly

• Park JH
• Kim DY
• Kim JW
• Park YS
• Seung WB

• KMID: 1426206
• DOI: http://doi.org/10.3340/jkns.2013.53.4.213

Abstract

OBJECTIVE
Transradial angiography has become popular among many cardiologists as a diagnostic and therapeutic tool. However, transradial cerebral angiography is not utilized to the same extent. The purpose of this study is to present our experience regarding the usefulness of transradial cerebral angiography, especially in elderly patients.
METHODS
Between May 2011 and February 2012, a total of 126 cerebral angiographies were performed via a transradial approach in a single center. Of them, only 47 patients were over 60 years old. In our institution, we shifted the initial access from the right femoral artery to the right radial artery in all patients requiring cerebral angiography in 2011. We did not attempt radial access in 40 cases for variable reasons.
RESULTS
The procedural success rate was 92.2%. We have four failures of transradial angiography; two because of loop formations of the radial and brachial artery and two due to multiple puncture failures. All supra-aortic vessels were successfully catheterized. However, the selective catheterization rates of the left side distal vessels were lower, as success rates were 89.7% for the right internal carotid artery and 75% for the left internal carotid artery. Procedure-related vascular complications, such as puncture site hematoma, hand ischemia, pseudoaneurysm, arteriovenous fistula and arterial dissection were not observed in our series. However, intraprocedural thrombosis developed in one patient, which was resolved completely by intraarterial thrombolytic agents.
CONCLUSION
With advancing patient's age, we believe that transradial cerebral angiography is a useful tool to decrease patient's discomfort and more effectively manage the vessel tortuosity.

Keyword

Angiography; Cerebral angiography; Radial artery; Transradial

MeSH Terms

Aged
Aneurysm, False
Angiography
Arteriovenous Fistula
Brachial Artery
Carotid Artery, Internal
Catheterization
Catheters
Cerebral Angiography
Femoral Artery
Glycosaminoglycans
Hand
Hematoma
Humans
Ischemia
Punctures
Radial Artery
Thrombosis
Glycosaminoglycans

Figure

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  Fig. 1 Loop formations as a cause of transradial approach failure (black arrows). These conditions make it difficult to introduce the guidewire and catheter because of loop formation of the brachial (A) and radial (B) arteries. Transradial approach failed in these cases.

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  Fig. 2 Acute thrombosis developed during transradial cerebral angiography of the right middle cerebral artery (A). And then, it resolved after intraarterial thrombolytic agents (B).

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