Related Experiment Video
Updated: Jun 25, 2026
Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
Published on: September 20, 2020
Predictors of difficult vascular access during transradial neurointervention: a retrospective study
Jian Wu1, Fei Zhang2, Quiping Li1
1Fudan University, Xiamen Branch, Zhongshan Hospital, Department of Neurosurgery - Xiamen, China.
Objective:
The aim of this study was to identify factors associated with difficulty in establishing vascular access during the transradial approach for neurointerventional therapy.
Methods:
We retrospectively analyzed consecutive patients who successfully underwent transradial approach neurointerventional therapy at Fudan Zhongshan Xiamen Hospital (July 2021-July 2024). Patients were categorized as "difficult" or "easy" according to whether vascular access establishment required >15 min. Collected variables included difficulty in radial artery puncture/sheath insertion, feasibility of routinely forming a Simmons-2 catheter, aortic arch type (II-III), tortuosity of the brachiocephalic trunk, brachiocephalic trunk-target common carotid artery angle (<30°), and tortuosity of the C2-C4 internal carotid artery. Multivariate logistic regression was performed to identify independent factors.
Results:
Among 277 patients, 199 were in the easy group and 78 were in the difficult group. Compared with the easy group, the difficult group more frequently had difficult radial puncture/sheath insertion, brachiocephalic trunk tortuosity, a sharp brachiocephalic trunk-target common carotid artery angle (<30°), C2-C4 internal carotid artery tortuosity, and failure to routinely form a Simmons-2 catheter (all p<0.05). Hypertension, diabetes, hyperlipidemia, and type III aortic arch were not significantly different between groups (all p>0.05). On multivariate analysis, difficult radial puncture/sheath insertion, inability to routinely form a Simmons-2 catheter, brachiocephalic trunk tortuosity, a brachiocephalic trunk-target common carotid artery angle <30°, and C2-C4 internal carotid artery tortuosity were independent factors associated with access difficulty (all p<0.001).
Conclusion:
Both access-site difficulty and unfavorable supra-aortic/internal carotid artery anatomy were independently associated with prolonged vascular access establishment during transradial approach neurointerventional therapy.
Related Concept Videos
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation