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Four French sheath-based transradial cerebral angiographies in the elderly: A single neurointerventionalist's
Dae Han Choi1, Chan Jong Yoo1, Cheol Wan Park1
1Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Insights
Transradial access (TRA) using a 4 F sheath is a feasible and safe option for cerebral angiography in elderly patients, showing reduced complications compared to transfemoral access (TFA). This technique offers a viable alternative for this population.
Area of Science:
- Neurointerventional Radiology
- Vascular Access Techniques
- Geriatric Cardiology
Background:
- Transradial access (TRA) offers lower access site complications than transfemoral access (TFA).
- Elderly patients face increased periprocedural complication risks.
- Smaller sheaths can mitigate access site complications in older individuals.
Purpose of the Study:
- To evaluate the feasibility and safety of 4 F sheath-based TRA for cerebral angiography in elderly patients (≥65 years).
- To compare 4 F sheath-based TRA cerebral angiography with TFA cerebral angiography in the elderly.
Main Methods:
- Retrospective review of medical records for elderly patients undergoing diagnostic cerebral angiography.
- Comparison between 57 TRA cases (4 F sheath) and 69 TFA cases (standard sheath size).
- Procedures performed by a single neurointerventionalist.
Main Results:
- No significant differences in age, accessed vessels, fluoroscopy time, or radiation exposure between TRA and TFA groups.
- Procedure duration was significantly shorter in the TRA group (17.2 min vs. 19.0 min).
- Access site complications were absent in the TRA group, versus 2.9% (groin hematoma) in the TFA group; 3.5% catheter kinks occurred in the TRA group.
Conclusions:
- 4 F sheath-based TRA is a feasible approach for diagnostic cerebral angiography in elderly patients.
- This technique demonstrates a favorable safety profile compared to TFA in this demographic.
- Careful catheter manipulation is advised during TRA procedures.
Background:
Catheter angiography via transradial access (TRA) is better at reducing access site complications and morbidity than via transfemoral access (TFA). The rate of periprocedural complications increases in elderly populations and using a smaller sheath can help reduce access site complications. The aim of this study was to assess the feasibility and safety of 4 F sheath-based TRA cerebral angiography in elderly patients (≥65 years) and compare it to TFA cerebral angiography.
Methods:
The medical records of elderly patients undergoing diagnostic cerebral angiography with a single neurointerventionalist via TRA (57 cases, from July 2019 to December 2020) versus TFA (69 cases, from January 2018 to June 2019) were retrospectively reviewed. All TRA angiographies were performed via right radial artery access with a 4 F sheath and a 4 F Simmons 2 catheter.
Results:
There were no significant differences (TRA vs. TFA) in age (71.1 ± 4.0 vs. 72.1 ± 4.6 years, p = 0.189), accessed vessels (3.9 ± 0.5 vs. 3.9 ± 0.6, p = 0.852), fluoroscopy time (7.1 ± 3.3 vs. 7.6 ± 3.5 min, p = 0.068), and radiation exposure (42.1 ± 15.8 vs. 47.0 ± 13.7 Gy-cm2, p = 0.067). However, the procedure duration was significantly shorter in the TRA group (17.2 ± 3.9 vs. 19.0 ± 6.0 min, p = 0.003). Painful groin hematoma occurred in 2 of the 69 cases (2.9%) in the TFA group. In the TRA group, access site complications were not occurred; however, catheter kinks occurred in 2 of 57 cases (3.5%).
Conclusions:
The 4 F sheath-based TRA is a feasible option for diagnostic cerebral angiography in elderly patients. However, care should be taken during catheter manipulation.
