Elsevier

Annals of Vascular Surgery

Volume 60, October 2019, Pages 236-245
Annals of Vascular Surgery

Clinical Research
Efficacy and Safety of a Novel Catheter for Transradial Cerebral Angiography

https://doi.org/10.1016/j.avsg.2019.03.036Get rights and content

Background

The goal of this study is to evaluate the safety and efficacy of a novel catheter for right radial artery approach cerebral angiography.

Methods

Patients from the Neurology Department of The Second Affiliated Hospital of Guangxi Traditional Chinese Medical University who underwent diagnostic cerebral angiography of either the left vertebral artery dominant type or balanced type were enrolled in this study.

Results

A total of 167 patients were treated between February 2016 and December 2017, of whom 44 were excluded based on study exclusion criteria and 123 were enrolled in the present analysis. Bilateral subclavian artery catheterization and bilateral common carotid artery catheterization were conducted successfully in all 123 patients. The success rate of selective catheterization of the left vertebral artery was 87.8% (108/123). The success rate of selective catheterization of the right vertebral artery using the novel catheter was 89.0% (73/82). The average fluoroscopy time was 6.5 ± 3.4 min, the average operation duration was 47 ± 3.7 (range 50–90) min, and the average dosage of contrast agent was 112.3 ± 8.1 mL. One patient exhibited an absence of pulse in the punctual radial artery after the removal of the arterial compression band, but there was no evidence of ischemia of the distal hand. One patient who was undergoing dual anti-platelet drug treatment suffered from bleeding at the puncture point when deflated for 2 hr after operation; this patient was re-pressurized and re-timed.

Conclusions

This novel catheter improved the success rate of selective left vertebral artery catheterization, and allowed for simplification of the relevant surgical steps. The controllability of this novel catheter was satisfactory, and its associated surgical risk was found to be low.

Section snippets

Background

Digital subtraction angiography (DSA) is a routinely performed transfemoral approach that has been employed since Bierman first reported it in 1951. However, complications such as puncture site hemorrhage, arteriovenous fistulas, and extended post-operative convalescence have been found to be associated with this procedure in clinical practice.1, 2, 3 The transradial approach was first introduced by Compeau in 1989 for diagnostic coronary angiography, and thereafter quickly gained widespread

Patient Recruitment

Patients of the Department of Neurology at the Affiliated RuiKang Hospital of the University of Traditional Chinese Medicine of Guangxi aged 50–80 years old, without contraindications for cerebral angiography, who intended to undergo transradial diagnostic cerebral angiography and who provided written informed consent were enrolled in this study. This study was approved by the Ethics Committee of the Affiliated RuiKang Hospital of the University of Traditional Chinese Medicine of Guangxi.

Patient Demographics

A total of 167 patients were enrolled, of whom those who were unable to maintain right wrist abduction and external rotation (n = 2) were excluded and were transferred to the left radial artery approach because of the right shoulder, elbow, or wrist deformity or restrictive lesions. Patients in whom pre-operative CTA/MRA found evidence of congenital dysplasia and occlusion of the left vertebral artery (n = 7), or who exhibited difficulty in selective intubation of the left vertebral artery due

Discussion

Increased operative difficulty has been the primary factor limiting the widespread use of transradial cerebral angiography in clinical practice. Although the change in puncture site can theoretically increase this difficulty, the route alteration from the puncture site to the supra-aortic vessels is in fact the primary source of increased difficulty associated with this procedure, and existing catheters cannot effectively adapt to this change.20

When approaching from the femoral artery, the path

Conclusions

This novel catheter significantly improved the success rate of selective left vertebral artery catheterization, and additionally simplified the surgical steps involved therein relative to other catheter designs. The maneuverability of this novel catheter was satisfactory for surgical use, with low risk and good clinical efficacy.

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    N.L. and W.Q. are co-first authors, first author and corresponding author contributed equally to this article.

    Source of funding: This project is funded by the National Natural Science Foundation of China (No. 81660205) and Key projects from the first-class discipline construct of Guangxi in 2018 (No. 2018XK089).

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