Feasibility and Radial Artery Occlusion Rate of Sheathless Distal Transradial Access Using Balloon Guide Catheters

doi:10.21203/rs.3.rs-4884565/v1

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Research Article

Feasibility and Radial Artery Occlusion Rate of Sheathless Distal Transradial Access Using Balloon Guide Catheters

https://doi.org/10.21203/rs.3.rs-4884565/v1

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Journal Publication

published 14 Oct, 2024

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Objectives

Distal transradial access (dTRA), performed through an anatomical snuffbox, minimizes post-procedural burdens of endovascular treatments. However, despite the benefits of balloon-guide catheters (BGCs), their use in dTRA is limited by their small radial artery diameter. Herein, we evaluated the feasibility and radial artery occlusion (RAO) rate of 8Fr BGCs used in sheathless dTRA.

Materials and Methods

This retrospective study reviewed patients treated with sheathless dTRA using an 8Fr Optimo at a single center between July 2023 and May 2024. dTRA procedures were performed under general anesthesia in patients not requiring urgent treatment. The RAO was assessed using ultrasonography 24 h after the procedure. The demographic and procedural characteristics were compared between the radial artery patency and occlusion groups.

Results

Of 170 patients, 50 underwent dTRA, and 43 (86%) completed the procedure. RAO occurred in 12/43 (28%) patients with dTRA. Univariate and receiver operating characteristic curve analyses demonstrated that the median radial artery diameter was significantly smaller in the RAO group (P < 0.001), with an optimal cut-off value of 2.4 mm to predict RAO. Complications included minor cerebral ischemia in two patients, but no severe ischemia was observed.

Conclusions

Sheathless dTRA using an 8Fr Optimo BGC is feasible, but the risk of RAO should be noted, particularly in patients with small radial artery diameters. This study suggests a radial artery diameter cutoff value of 2.4 mm to predict RAO, aiding access decisions for large-bore BGC. Further multicenter prospective studies are warranted to confirm these findings and assess long-term outcomes.

distal transradial access

balloon guide catheter

sheathless access

radial artery occlusion

radial artery diameter

neuroendovascular procedure

Compared with transfemoral access (TFA), transradial access (TRA) facilitates early ambulation and reduces access site complications [1–3]. Additionally, TRA is indicated for patients with unfavorable vascular anatomy and access-site lesions such as type 3 aortic arch, tortuous bovine origin of the left common carotid artery, aortic wall calcification, aortic dissection, or femoral artery occlusion [3–5]. Distal transradial access (dTRA), which involves the puncture of the radial artery via the anatomical snuffbox on the dorsum of the hand, is increasingly utilized in the cardiovascular field because of its potential to further reduce the post-procedural burden, without restricting wrist flexion [6].

The efficacy of balloon-guide catheter (BGC) in endovascular treatment has been reported, while further research has indicated that dTRA using BGCs may offer benefits including a reduced patient burden, enhanced safety, and improved effectiveness [5, 7, 8]. However, the small diameter of the radial artery limits the use of BGCs [9, 10], and post-interventional radial artery occlusion (RAO) remains a concern [11, 12]. Large-bore BGCs can be used without sheath insertion to mitigate the burden on the radial artery; however, the feasibility and rate of RAO remain unclear due to the paucity of previous reports [10, 13, 14]. Recently, BGCs with larger inner diameters and improved flexibility have been developed [4, 14]. The 8Fr Optimo (Tokai Medical Products, Japan) is a BGC with a wide inner diameter capable of accommodating a 6Fr. distal access catheter, thereby expanding treatment options. Herein, we aimed to assess the feasibility and factors influencing the development of RAO using an 8Fr BGC for sheathless dTRA. To our knowledge, this is the first retrospective study to evaluate the rate of RAO in large-bore BGCs using dTRA.

We retrospectively reviewed patients treated with sheathless dTRA using an 8Fr Optimo under general anesthesia for the treatment of the anterior circulation at our center from July 2023 to May 2024. For urgent treatment or for patients with systemic comorbidities that make general anesthesia unfavorable, we performed endovascular procedures using TFA. To the best of our knowledge, there have been no reports of hand ischemia secondary to distal RAO. Therefore, we attempted dTRA without considering the radial artery diameter. We investigated procedural success and conversion rates to conventional TRA or TFA.

Treatment and post-procedural hemostasis

Under general anesthesia, the procedure was initiated with puncture of the distal radial artery using the snuffbox as a landmark, followed by placement of a 3.3 Fr short sheath. A 0.035-inch guidewire and TMP dilator (Tokai Medical Products, Japan) were then used to exchange the short sheath with an 8Fr Optimo. The 8Fr Optimo was guided to the target vessel using a 6Fr. SY3 (Gadelius Medical, Tokyo, Japan). Hemostasis was achieved using the external radial compression device, the PreludeSync Distal Band (Merit Medical). While withdrawing the 8Fr Optimo, air was injected using a 10 ml syringe to achieve hemostasis. Air was gradually released until oozing was observed, after which air was re-injected until hemostasis was confirmed. Air was removed at a rate of 1 ml per hour, and if bleeding occurred, 1 ml of air was added, and the process was repeated. When the remaining air was reduced to 4 ml, the device was removed and compression was stopped.

Assessment of radial artery occlusion

We evaluated the patency of the radial artery in the forearm using ultrasound 24 h following the endovascular procedures, and classified the patients into two groups based on the results. The following factors were compared between the two groups: age, sex, and atherosclerosis risk factors, such as hypertension, diabetes mellitus, dyslipidemia, and smoking. We also compared the underlying diseases, treatment details, number of procedures, whether the procedure was performed by a physician board certified by the Japanese Society for Neuroendovascular Therapy, radial artery diameter, radial artery spasm, intraoperative heparin dose, puncture time, and operative time. Radial artery diameter was defined as the average of the minimum inner diameters of three sections of the radial artery, which were measured following contrast injection during the insertion of a short sheath [15].

Complications and clinical outcomes:

The rates of cerebral complications and peripheral ischemic complications were evaluated, as well as clinical outcomes using the modified Rankin Scale (mRS) at discharge.

Statistical Analysis

Continuous variables are shown as the mean and standard deviation and were compared using Student’s t-test if normally distributed; otherwise, non-normally distributed data are shown as median and interquartile range and were compared using the Mann–Whitney U-test. Categorical variables are expressed as numbers and percentages and were compared using the chi-square or Fisher’s exact test. Statistical significance was set at P < 0.05. A receiver operating characteristic (ROC) curve was used to predict the factors associated with RAO and the cutoff value was set when the risk of RAO was high. Statistical analyses were performed using Easy R version 1.41, a graphical user interface for R (R Core Team (2013). R: Language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL http://www.R-project.org/).

Feasibility of distal transradial access:

Figure 1 presents a flowchart of patient enrollment. TFA was performed in 120 of 170 patients, the details of which are as follows: 87 patients underwent mechanical thrombectomy, 18 underwent coiling for cerebral aneurysms, 3 had flow diverters for cerebral aneurysms, 5 underwent carotid artery stenting (CAS), 2 underwent intracranial stenting, 4 underwent embolization for arteriovenous malformations, and 1 had an arteriovenous fistula. Consequently, 50 patients underwent dTRA, of whom 43 (86%) successfully completed the procedure. Three patients switched to conventional radial access due to difficulties in puncturing the distal radial artery. Four patients underwent conversion to TFA; in two patients, the 8Fr Optimo was lodged in the radial artery and could not be guided into the brachial artery, while one patient had difficulty in selecting the left common carotid artery due to an aberrant subclavian artery, and in the other patient, kinking in the proximal portion of the internal carotid artery occurred.

Factors affecting radial artery occlusion:

Of the 43 patients in whom distal radial access was performed, 31 (78%) were classified into the radial artery patency (RAP) group and 12 (28%) into the RAO group. Table 1 compares the demographic characteristics between the RAP and RAO groups. The median age of the patients was 67 years (interquartile range (IQR) 54–73), and 15 patients (35%) were male. Comorbidities such as hypertension, diabetes mellitus, dyslipidemia, and smoking were present in 14 (33%), 6 (14%), 28 (65%), and 13 (30%) patients, respectively. The illnesses included cerebral aneurysms in 28 patients (65%), cervical internal carotid artery stenosis in 11 (26%), intracranial stenosis in 2 (4.7%), arteriovenous malformation in 1 (2.3%), and arteriovenous fistula in 1 (2.3%).

Table 1

Comparison of demographic characteristics between the radial artery patency and occlusion groups.
	All	RA patent	RA occlusion
No.	43	31	12	P value
Age, years	67 (54–73)	62 (54-72.5)	72.5 (60.3–74)	0.25
Male, n (%)	15 (35%)	13 (42%)	2 (17%)	0.23
Hypertension, n (%)	14 (33%)	8 (25%)	6 (50%)	0.25
Diabetes Mellitus, n (%)	6 (14%)	4 (13%)	2 (17%)	1
Dyslipidemia, n (%)	28 (65%)	19 (61%)	9 (75%)	0.63
Smoking, n (%)	13 (30%)	8 (26%)	5 (42%)	0.56
Illness				0.77
Cerebral aneurysm, n (%)	28 (65%)	21 (68%)	7 (58%)
CICS, n (%)	11 (26%)	7 (23%)	4 (33%)
Intracranial stenosis, n (%)	2 (4.7%)	1 (3.2%)	1 (8.3%)
AVM, n (%)	1 (2.3%)	1 (3.2%)	0 (0%)
AVF, n (%)	1 (2.3%)	1 (3.2%)	0 (0%)
RA, radial artery; CICS, cervical carotid artery stenosis; AVM, arteriovenous malformation
AVF, arteriovenous fistula

Table 2 compares the procedural characteristics between the RAP and RAO groups. The treatment procedures included coiling for cerebral aneurysms in 18 patients (42%), flow diverter placement in 10 (23%), CAS in 11 (26%), intracranial stenting in 2 (4.7%), embolization for arteriovenous malformation in 1 (2.3%), and embolization for arteriovenous fistula in 1 (2.3%). The number of treatments was as follows: first-time treatment in 35 patients (81%), second-time treatment in 8 (19%), and treatment performed by neurovascular specialists in 16 (37%). The median radial artery diameter was 2.6 mm (IQR 2.15–2.9), while radial artery spasm occurred in 9 patients (21%). The dose of intraoperative heparin was 3 mL (IQR 3-4.75). The median puncture time was 4 minutes (IQR 2–13), whereas the operation time was 119 minutes (104–169). Univariate analysis revealed that the radial artery diameter was associated with RAO (p < 0.001). Further, ROC curve analysis revealed a relationship between the radial artery diameter and its occlusion, with an area under the curve of 0.942 (Fig. 2). The optimal cutoff value for RAO was 2.4 mm, yielding an optimal sensitivity and specificity of 0.917 and 0.871, respectively. Table 3 shows the total number of complications and the clinical outcomes. Cerebral ischemia occurred in two patients (4.7%), both times related to coil embolization. One patient was asymptomatic and the other developed amaurosis. None of the patients presented persistent pain, sensory disturbances, necrosis, or other peripheral ischemic symptoms associated with RAO. An mRS of 0–2 was observed in 28 patients (65%).

Table 2

Comparison of procedural characteristics between the radial artery patency and occlusion groups.
	All	RA patent	RA occlusion	p value
No.	43	31	12
Procedure				0.87
Coiling for cerebral aneurysm, n (%)	18 (42%)	14 (45%)	4 (33%)
Flow diverter, n (%)	10 (23%)	7 (23%)	4 (33%)
CAS, n (%)	11 (26%)	7 (23%)	3 (25%)
Intracranial stenting, n (%)	2 (4.7%)	1 (3.2%)	1 (8.3%)
Embolization for AVM, n (%)	1 (2.3%)	1 (3.2%)	0 (0%)
Embolization for AVF, n (%)	1 (2.3%)	1 (3.2%)	0 (0%)
No. of treatments				1
First time, n (%)	35 (81%)	25 (81%)	10 (83%)
Second time, n (%)	8 (19%)	6 (19%)	2 (17%)
Treatment performed by board certificated neurosurgeons, n (%)	16 (37%)	12 (39%)	4 (33%)	1
Radial artery diameter, mm	2.6 (2.15–2.9)	2.8 (2.55–3.1)	1.85 (1.58–2.08)	< 0.001
Radial artery spasm, n (%)	9 (21%)	5 (16%)	4 (33%)	0.41
Dose of intraoperative heparin, mL	3 (3-4.75)	4 (3–5)	3 (3–4)	0.27
Puncture time, minutes	4 (2–13)	4 (2.5–11)	4 (2.25–15.25)	0.97
Operation time, minutes	119 (104–169)	119 (97–159)	129 (113–175)	0.4
RA, radial artery; CAS, carotid artery stenting; AVM, arteriovenous malformation; AVF, arteriovenous fistula
*p < 0.05 indicates significance.

Table 3

Total treatment complications and clinical outcomes (n = 43).
Cerebral complications, n (%)	2 (4.7%)
Ischemia, n (%)	2 (4.7%)
Hemorrhage, n (%)	0 (0%)
Peripheral ischemic symptoms, n (%)	0 (0%)
mRS 0–2 at discharge, n (%)	28 (65%)
mRS at discharge, n (%)
0	19 (44%)
1	7 (16%)
2	2 (4.7%)
3	1 (2.3%)
4	1 (2.3%)
5, 6	0 (0%)
mRS, modified Rankin Scale

The present study demonstrated the feasibility of sheathless dTRA using an 8Fr BGC. Conversion to TFA was required in four of the 50 patients (8%). Of these four patients switched to TFA, the brachial artery could not be accessed because the BGCs were obstructed in the radial artery in two patients. In one patient, the diagnostic catheter could not select the target vessel, while in another patient, kinking occurred after the BGC was guided to the target vessel.

The efficacy of BGC has been well documented in prior studies [5, 8, 13, 16]. Indeed, one multicenter prospective study indicated that the use of BGC for mechanical thrombectomy is associated with a higher first-pass effect rate and reduced procedure time, leading to decreased National Institutes of Health Stroke Scale scores from admission to 24 h, and a lower 90-day mortality rate compared with non-BGC patients [7]. Furthermore, through flow control, BGC contributes to the navigability of microcatheters in the internal carotid artery, enhancing the stability of coils in anterior circulation aneurysms [17], [18]. In one retrospective study investigating coil embolization for anterior circulation aneurysms, proximal balloon inflation was used to stabilize the framing coil when it deviated from the parent vessel. In this study, flow control using a proximal balloon was performed in 43 of the 206 patients, and no procedure-related complications were observed [18]. Additionally, the use of BGC for flow reversal has been reported to facilitate safe treatment in CAS [5, 8, 13, 16]. In the present study, minor cerebral ischemia occurred as a complication of the procedure in two patients (4.7%). The use of BGC in neuroendovascular therapy was found to be effective with acceptable complication rates. Nevertheless, the small inner and large outer diameters of the BGC make it challenging to approach it through small-caliber vessels. Further, the double-lumen design is associated with trackability issues. Consequently, reports on dTRA using BGC are limited [5, 10]. Rajah et al. were the first to report mechanical thrombectomy using dTRA with a BGC [10]; in their study, they placed a 7Fr Glide sheath and guided a 6 + Cello Balloon Guide (Medtronic). Because of the small internal diameter, which could not accommodate 4Fr or 5Fr Simonds, the target vessel was selected with a glide wire, and the BGC was guided. However, this method was associated with a prolonged procedure times and anatomical limitations when approaching a target vessel. Additionally, concerns have been raised regarding the inability to perform emergency CAS due to the profile limitations of BGC. To guide large-bore BGCs, a sheathless access method can be utilized [13]. In one previously-reported case series, patients anticipating difficulties with TFA were selected, and a 9Fr Optimo was guided through the brachial artery without using a sheath for CAS [13]. Although kinking occurred in one of the eight patients, which necessitated a change of BGC, the procedure success rate was 100%, which necessitated a change in the BGC. Due to the lack of consideration of the radial artery diameter in this study, the BGCs became lodged in the radial artery in 2 out of 50 patients (4%). Guiding large-bore BGCs without using a sheath appears to be effective; however, it is necessary to consider the diameter of the radial artery.

Recently, BGCs with larger inner diameters that exhibit enhanced flexibility have been introduced [4, [14]. Flowgate 2 (Stryker Neurovascular, USA) has an outer diameter of 2.7 mm and an inner diameter of 0.084 in, and cannot accommodate a 0.071 inch large-bore aspiration catheter [4, 19]. In one retrospective study using an 8Fr Flowgate 2 for mechanical thrombectomy using TRA, radial artery vasospasm occurred in 3 of 20 patients, while kinking occurred in 4 patients [4]. In contrast, the Walrus (Q’Apel Medical, USA) has an outer diameter of 2.79 mm and an inner diameter of 0.087 in, allowing the use of a 0.071 inch large-bore aspiration catheter. Dossani et al. reported a case series of 10 patients with acute ischemic stroke due to large vessel occlusion treated with mechanical thrombectomy using a sheathless TRA with a Walrus BGC [14]. In this case series, TRA was achieved in all patients regardless of the radial artery diameter, while no kinking occurred. The 8Fr Optimo has an outer diameter of 2.67 mm, which is smaller than that of the Walrus. However, its inner diameter is 0.087 in, which is similar to that of the Walrus. The 8Fr Optimo can accommodate a 6Fr distal access catheter, enabling the use of a double microcatheter and a combination of a microcatheter and balloon in aneurysm treatment. In addition, CAS is possible. In our study, only 1 of 50 patients (2%) required TFA because of kinking of the internal carotid artery. Given its profile with a wide inner diameter, small outer diameter, trackability, and wide range of treatment options, sheathless dTRA using the 8Fr Optimo is considered a valuable treatment option.

In this retrospective study, sheathless distal radial access using an 8Fr BGC was performed regardless of radial artery diameter. Overall, we found that RAO occurred in 12 of the 43 patients (28%), and the radial artery diameter was significantly smaller in the occlusion group. Previous reports have indicated an occlusion rate of 0–5% with dTRA, whereas our study showed a higher RAO rate [5, 12, 20, 21]. In earlier studies, the choice of approach was left to the discretion of the physicians, and preoperative ultrasound was used to measure the vessel diameter and assess suitability [5, 12, 21]. Additionally, compared with our study, treatments using smaller sheaths may have resulted in lower occlusion rates [20]. Patient-related risk factors for RAO include female sex; diabetes mellitus; atherosclerotic factors such as dyslipidemia and peripheral arterial disease; small caliber of the radial artery; and repeated cannulation, which can cause intimal hyperplasia and media thickening, resulting in a reduced lumen diameter [11, 22]. Further, procedure-related risk factors, such as multiple punctures, radial artery spasm, long procedural and hemostasis times, and occlusive hemostasis have also been reported [11]. In a retrospective analysis of cardiovascular interventions performed via dTRA, a distal radial artery inner diameter-to-sheath outer diameter ratio of less than 1 was identified as an independent risk factor for distal RAO [12]. In our study, with a cutoff value for predicting RAO is 2.4 mm, this ratio was 0.92. According to previous findings, when employing large-bore BGCs for dTRA, careful consideration is necessary if the inner diameter of the radial artery closely matches the outer diameter of the sheath, which may result in radial artery occlusion.

RAO is usually asymptomatic [22], and severe hand ischemia is rare [23, 24]. Moreover, even if RAO occurs after a neuroendovascular procedure using TRA, retreatment may be possible. In one retrospective study involving 46 patients who underwent repeated TRA, RAO occurred in 13. Recanalization was achieved in a median of 6 days in all patients using a radial artery catheterization set that included the movable guidewire and outer sheath, allowing for subsequent neuroendovascular procedures [25]. Although symptomatic RAO was not observed in this study, in such cases, recanalization therapy may be required, and the artery becomes unusable for future access routes [24, 25]. Our indications for dTRA using an 8Fr BG may have the potential for improvement, considering a cutoff value of 2.4 mm for the inner diameter of the radial artery.

The present study has some limitations. First, patient data were collected retrospectively from a single institution. As such, further multicenter prospective studies are required to confirm these findings. Second, selection bias may have occurred as 120 patients requiring urgent treatment or with significant comorbidities were treated with TFA, most of whom underwent mechanical thrombectomy. In addition, seven patients switched their treatment to another access. As a result, only 43 patients treated with dTRA were analyzed. Finally, the study did not provide long-term follow-up results of patients who developed radial artery occlusion. Spontaneous recanalization can be observed, and a meta-analysis showed that the incidence of radial artery occlusion within 24 h was 7.7%, which decreased to 5.5% after more than 1 week of follow-up [12, 26]. Further follow-up is needed to assess the long-term RAO rates.

We found that in sheathless dTRA using an 8Fr BGC, the radial artery diameter was associated with RAO 24 h following the procedure; further, we identified a cutoff value of the radial artery diameter to predict vascular occlusion of 2.4 mm. These findings can help physicians predict RAO and make decisions regarding the optimal endovascular access.

Competing Interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Committee on Human Research at Saitama International Medical Center (approval no.: 14–196).

Consent to participate
The requirement for informed consent was waived owing to the retrospective nature of the study.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author Contribution

Author contributionsK.O.: Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft preparation. M.Y.: Writing – reviewing & editing. K.A.: Data curation, Formal analysis. N.Y.: Data curation, Formal analysis. R.K.: Data curation, Formal analysis. R.K.: Data curation, Formal analysis. K.S.: Supervision.

Acknowledgement

We would like to thank Editage (www.editage.com) for the English language editing.

Megaly M, Karatasakis A, Abraham B et al (2019) Radial Versus Femoral Access in Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Interv 12:e007778. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007778
Chiarito M, Cao D, Nicolas J et al (2021) Radial versus femoral access for coronary interventions: An updated systematic review and meta-analysis of randomized trials. Catheter Cardiovasc Interv 97:1387–1396. https://doi.org/10.1002/ccd.29486
Tanoue S, Ono K, Yoshiura T, Miyama M, Okawa H, Shirotani T (2021) Distal Transradial Approach in Mechanical Thrombectomy: Technical Note. J Neuroendovasc Ther 15:408–414. https://doi.org/10.5797/jnet.tn.2020-0060
Martinez-Galdamez M, Schuller M, Galvan J, de Lera M, Kalousek V, Ortega-Gutierrez S, Arenillas JF (2022) Safety and feasibility of transradial use of 8F balloon guide catheter Flowgate(2) for endovascular thrombectomy in acute ischemic stroke. Interv Neuroradiol 28:22–28. https://doi.org/10.1177/15910199211013186
Sato D, Umekawa M, Koizumi S, Ishigami D, Kiyofuji S, Saito N (2024) Trans-Distal Radial Artery Carotid Revascularization with Forearm Flow Reversal: An Alternative Option of CAS in the TCAR Era. World Neurosurg 183:e920–e927. https://doi.org/10.1016/j.wneu.2024.01.058
Corcos T (2019) Distal radial access for coronary angiography and percutaneous coronary intervention: A state-of-the-art review. Catheter Cardiovasc Interv 93:639–644. https://doi.org/10.1002/ccd.28016
Blasco J, Puig J, Daunis IEP et al (2021) Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology. J Neurointerv Surg 13:773–778. https://doi.org/10.1136/neurintsurg-2020-017027
Moldovan K, Yaeger KA, Al-Kawaz M et al (2023) Transradial Carotid Artery Stenting Using Walrus Balloon Guide Catheter: Technical Aspects and Clinical Outcome. Oper Neurosurg (Hagerstown) 25:28–32. https://doi.org/10.1227/ons.0000000000000717
McCarthy DJ, Chen SH, Brunet MC, Shah S, Peterson E, Starke RM (2019) Distal Radial Artery Access in the Anatomical Snuffbox for Neurointerventions: Case Report. World Neurosurg 122:355–359. https://doi.org/10.1016/j.wneu.2018.11.030
Rajah GB, Lieber B, Kappel AD, Luqman AW (2020) Distal transradial access in the anatomical snuffbox for balloon guide-assisted stentriever mechanical thrombectomy: Technical note and case report. Brain Circ 6:60–64. https://doi.org/10.4103/bc.bc_22_19
Tsigkas G, Papanikolaou A, Apostolos A et al (2023) Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations. J Cardiovasc Dev Dis 10. https://doi.org/10.3390/jcdd10070283
Chen T, Li L, Yang A et al (2023) Incidence of Distal Radial Artery Occlusion and its Influencing Factors After Cardiovascular Intervention Via the Distal Transradial Access. J Endovasc Ther 15266028231208638. https://doi.org/10.1177/15266028231208638
Koge J, Iwata T, Hashimoto T et al (2018) Carotid artery stenting with proximal embolic protection via the transbrachial approach: sheathless navigation of a 9-F balloon-guiding catheter. Neuroradiology 60:1097–1101. https://doi.org/10.1007/s00234-018-2085-2
Dossani RH, Waqas M, Monteiro A et al (2022) Use of a sheathless 8-French balloon guide catheter (Walrus) through the radial artery for mechanical thrombectomy: technique and case series. J Neurointerv Surg 14. https://doi.org/10.1136/neurintsurg-2021-017868
Imaoka Y, Kohyama S, Iijima S et al (2023) Simplified Transradial Access for Aneurysms Treatment: A Guiding System Using Solo Distal Access Catheter and Anatomical Considerations. World Neurosurg 179:e444–e449. https://doi.org/10.1016/j.wneu.2023.08.116
Tanoue S, Ono K, Toyooka T, Nakagawa M, Wada K (2024) Carotid Artery Stenting via Radial Access with Modified Flow Reversal Method: Case Series. World Neurosurg 181:e906–e910. https://doi.org/10.1016/j.wneu.2023.11.012
Son W, Kang DH, Park J, Kwak Y, Kim M, Kim BJ (2021) Advantage of Balloon Guide Catheter During Endovascular Treatment of Direct Carotid-Cavernous Sinus Fistula: Technical Note and Report of 2 Cases. World Neurosurg 145:251–255. https://doi.org/10.1016/j.wneu.2020.09.058
Ohshima T, Miyachi S, Matsuo N et al (2018) Efficacy of the proximal balloon flow control method for endovascular coil embolisation as a novel adjunctive technique: A retrospective analysis. Interv Neuroradiol 24:375–378. https://doi.org/10.1177/1591019918763614
Cortez GM, Turner RD, Monteiro A et al (2022) Walrus large bore guide catheter impact on recanalization first pass effect and outcomes: the WICkED study. J Neurointerv Surg 14:280–285. https://doi.org/10.1136/neurintsurg-2021-017494
Koutouzis M, Kontopodis E, Tassopoulos A et al (2019) Distal Versus Traditional Radial Approach for Coronary Angiography. Cardiovasc Revasc Med 20:678–680. https://doi.org/10.1016/j.carrev.2018.09.018
Hammami R, Zouari F, Ben Abdessalem MA et al (2021) Distal radial approach versus conventional radial approach: a comparative study of feasibility and safety. Libyan J Med 16:1830600. https://doi.org/10.1080/19932820.2020.1830600
Wagener JF, Rao SV (2015) Radial artery occlusion after transradial approach to cardiac catheterization. Curr Atheroscler Rep 17:489. https://doi.org/10.1007/s11883-015-0489-6
Rademakers LM, Laarman GJ (2012) Critical hand ischaemia after transradial cardiac catheterisation: an uncommon complication of a common procedure. Neth Heart J 20:372–375. https://doi.org/10.1007/s12471-012-0276-8
Valentine RJ, Modrall JG, Clagett GP (2005) Hand ischemia after radial artery cannulation. J Am Coll Surg 201:18–22. https://doi.org/10.1016/j.jamcollsurg.2005.01.011
Cai R, Jiang Y, Wu J, Li Q, Qi B (2024) Feasibility of early radial artery occlusion recanalization and reuse through transradial access for neuroendovascular procedures. BMC Neurol 24:50. https://doi.org/10.1186/s12883-024-03549-8
Rashid M, Kwok CS, Pancholy S et al (2016) Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis. J Am Heart Assoc 5. https://doi.org/10.1161/JAHA.115.002686

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Feasibility and Radial Artery Occlusion Rate of Sheathless Distal Transradial Access Using Balloon Guide Catheters

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Journal Publication

Version 1

Abstract

Objectives

Materials and Methods

Results

Conclusions

Figures

Introduction

Materials and Methods: Patient selection

Treatment and post-procedural hemostasis

Assessment of radial artery occlusion

Complications and clinical outcomes:

Statistical Analysis

Results

Feasibility of distal transradial access:

Factors affecting radial artery occlusion:

Discussion

Conclusion

Declarations

Competing Interests

Ethics approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Committee on Human Research at Saitama International Medical Center (approval no.: 14–196).

Consent to participate
The requirement for informed consent was waived owing to the retrospective nature of the study.

Funding

Author Contribution

Acknowledgement

References

Additional Declarations

Status:

Journal Publication

Version 1

Feasibility and Radial Artery Occlusion Rate of Sheathless Distal Transradial Access Using Balloon Guide Catheters

Status:

Journal Publication

Version 1

Abstract

Objectives

Materials and Methods

Results

Conclusions

Figures

Introduction

Materials and Methods: Patient selection

Treatment and post-procedural hemostasis

Assessment of radial artery occlusion

Complications and clinical outcomes:

Statistical Analysis

Results

Feasibility of distal transradial access:

Factors affecting radial artery occlusion:

Discussion

Conclusion

Declarations

Competing Interests

Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Committee on Human Research at Saitama International Medical Center (approval no.: 14–196).

Consent to participate The requirement for informed consent was waived owing to the retrospective nature of the study.

Funding

Author Contribution

Acknowledgement

References

Additional Declarations

Status:

Journal Publication

Version 1

Ethics approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Committee on Human Research at Saitama International Medical Center (approval no.: 14–196).

Consent to participate
The requirement for informed consent was waived owing to the retrospective nature of the study.