Radial access for neurointervention: room set-up and technique for diagnostic angiography

A number of prospective randomized trials have shown that the radial artery is a safer access site than the femoral artery for endovascular procedures.1-4 In the cardiac literature there was a 60% reduction in access site complications as well as significant decreases in all-cause mortality with the transradial approach compared with the transfemoral approach, which has led to the adoption of a radial first strategy.5-7 The neurointerventional literature has demonstrated similar safety benefits as well as improved patient preference.8-14 However, the technical aspects of how to perform neurointervention via the radial approach are still unknown to the majority of neurointerventionalists. This technical video 1 covers the details of how to perform a diagnostic angiogram via the radial approach. Initially, steps such as pre-procedure preparation, room set-up, and patient positioning are discussed. Following this, puncture techniques and sheath placement are outlined, including the snuffbox technique. The steps of a full six-vessel cerebral angiogram are then shown in detail. Finally, closure techniques are demonstrated. neurintsurg;13/1/96/V1F1V1Video 1 The image in the opening frame and at 2:24 is reused with permission from Brunet et al, Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography. J Neurointerv Surg 2019;11:710-3. Copyright 2019 BMJ Publishing Group.The other image in the opening frame is reused with permission from Chen et al, Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study. J Neurointerv Surg, 2019;11:796-800. Copyright 2019 BMJ Publishing Group.The images at 0:38 and 8:24 are reused with permission from Snelling et al, Transradial cerebral angiography: techniques and outcomes. J Neurointerv Surg 2018;10:874-81. Copyright 2018 BMJ Publishing Group.