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Eric C. Peterson - One of the best experts on this subject based on the ideXlab platform.
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left transradial access for Cerebral Angiography
Journal of NeuroInterventional Surgery, 2020Co-Authors: Guilherme Barros, Eric C. Peterson, David I Bass, Joshua W Osbun, Stephanie H Chen, Marie Christine Brunet, Melanie Walker, Cory M Kelly, Michael R LevittAbstract:Introduction Transradial access is increasingly used among neurointerventionalists as an alternative to the transfemoral route. Currently available data, building on the interventional cardiology experience, primarily focus on right radial access. However, there are clinical scenarios when left-sided access may be indicated. The purpose of this study was to evaluate the technical feasibility of left transradial access to Cerebral Angiography across three institutions. Methods A retrospective chart review was performed for patients who underwent Cerebral Angiography accessed via the left radial artery at three institutions between January 2018 and July 2019. The outcome variables studied were successful catheterization, vascular complications, and fluoroscopic time. Results Nineteen patients underwent a total of 25 Cerebral angiograms via left transradial access for Cerebral aneurysms (n=15), basilar occlusion (n=1), carotid stenosis (n=1), arteriovenous malformation (n=1), and cervical neurofibroma (n=1). There were 12 diagnostic angiograms and 13 interventional angiograms. The left transradial approach was chosen due to left vertebrobasilar pathology (n=22), right subclavian stenosis (n=2), and previous right arm amputation (n=1). There was one instance of radial artery spasm, which resolved after catheter removal, and one conversion to transfemoral access in an interventional case due to lack of distal catheter support. There were no procedural complications. Conclusions Left transradial access in diagnostic and interventional Cerebral Angiography is a technically feasible, safe, and an effective alternative when indicated, and may be preferable for situations in which pathology locations or anatomic limitations preclude right-sided radial access.
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Transradial Cerebral Angiography: techniques and outcomes.
Journal of NeuroInterventional Surgery, 2018Co-Authors: Brian Snelling, Samir Sur, Sumedh S. Shah, Priyank Khandelwal, Justin M. Caplan, Rianna Haniff, Robert M. Starke, Dileep R. Yavagal, Eric C. PetersonAbstract:Background Despite several retrospective studies analyzing the safety and efficacy of transradial access (TRA) versus transfemoral access (TFA) for Cerebral Angiography, this transition for neurointerventional procedures has been gradual. Nonetheless, based on our positive initial institutional experience with TRA for mechanical thrombectomy in acute ischemic stroke patients, we have started transitioning more of our Cerebral Angiography cases to TRA. Here we present our single institution experience. Methods We performed a retrospective review of patients receiving TRA Cerebral Angiography at our institution between January 2016 and February 2017. We present our experience transitioning from TFA to TRA, including our criteria for patient selection, technical nuances, patient experience, complications, and operator learning curve. Results We included 148 angiograms performed in 141 people by one of four operators. No major complications were observed, and the technical success of the procedures was consistent with those of TFA. Marked improvement in operator efficiency was achieved in a short number of cases during this transition when looking at operator proficiency as a function of angiograms performed and days of exposure to TRA (4.3 vs 3.6 min/vessel, P Conclusions Safety and efficiency can be preserved while transitioning to TRA. While further investigation is necessary to support transition to TRA, these findings should call for a re-evaluation of the role of TRA in catheter Cerebral Angiography.
Michael R Levitt - One of the best experts on this subject based on the ideXlab platform.
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left transradial access for Cerebral Angiography
Journal of NeuroInterventional Surgery, 2020Co-Authors: Guilherme Barros, Eric C. Peterson, David I Bass, Joshua W Osbun, Stephanie H Chen, Marie Christine Brunet, Melanie Walker, Cory M Kelly, Michael R LevittAbstract:Introduction Transradial access is increasingly used among neurointerventionalists as an alternative to the transfemoral route. Currently available data, building on the interventional cardiology experience, primarily focus on right radial access. However, there are clinical scenarios when left-sided access may be indicated. The purpose of this study was to evaluate the technical feasibility of left transradial access to Cerebral Angiography across three institutions. Methods A retrospective chart review was performed for patients who underwent Cerebral Angiography accessed via the left radial artery at three institutions between January 2018 and July 2019. The outcome variables studied were successful catheterization, vascular complications, and fluoroscopic time. Results Nineteen patients underwent a total of 25 Cerebral angiograms via left transradial access for Cerebral aneurysms (n=15), basilar occlusion (n=1), carotid stenosis (n=1), arteriovenous malformation (n=1), and cervical neurofibroma (n=1). There were 12 diagnostic angiograms and 13 interventional angiograms. The left transradial approach was chosen due to left vertebrobasilar pathology (n=22), right subclavian stenosis (n=2), and previous right arm amputation (n=1). There was one instance of radial artery spasm, which resolved after catheter removal, and one conversion to transfemoral access in an interventional case due to lack of distal catheter support. There were no procedural complications. Conclusions Left transradial access in diagnostic and interventional Cerebral Angiography is a technically feasible, safe, and an effective alternative when indicated, and may be preferable for situations in which pathology locations or anatomic limitations preclude right-sided radial access.
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transradial intraoperative Cerebral Angiography a multicenter case series and technical report
Journal of NeuroInterventional Surgery, 2020Co-Authors: Joshua W Osbun, Michael R Levitt, Bhuvic Patel, Alexander T Yahanda, Amar S Shah, Kathleen M Dlouhy, Joshua P Thatcher, Michael R Chicoine, Louis J Kim, Gregory J ZipfelAbstract:Background Use of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative Cerebral Angiography. Objective To report a multicenter experience on the use of radial artery access in intraoperative Cerebral Angiography, including case series and discussion of technical nuances. Methods 27 patients underwent attempted transradial Cerebral Angiography between May 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications. Results 24 of the 27 patients (88.8%) underwent successful transradial intraoperative Cerebral Angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication. Conclusions Transradial intraoperative Cerebral Angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.
Joshua W Osbun - One of the best experts on this subject based on the ideXlab platform.
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left transradial access for Cerebral Angiography
Journal of NeuroInterventional Surgery, 2020Co-Authors: Guilherme Barros, Eric C. Peterson, David I Bass, Joshua W Osbun, Stephanie H Chen, Marie Christine Brunet, Melanie Walker, Cory M Kelly, Michael R LevittAbstract:Introduction Transradial access is increasingly used among neurointerventionalists as an alternative to the transfemoral route. Currently available data, building on the interventional cardiology experience, primarily focus on right radial access. However, there are clinical scenarios when left-sided access may be indicated. The purpose of this study was to evaluate the technical feasibility of left transradial access to Cerebral Angiography across three institutions. Methods A retrospective chart review was performed for patients who underwent Cerebral Angiography accessed via the left radial artery at three institutions between January 2018 and July 2019. The outcome variables studied were successful catheterization, vascular complications, and fluoroscopic time. Results Nineteen patients underwent a total of 25 Cerebral angiograms via left transradial access for Cerebral aneurysms (n=15), basilar occlusion (n=1), carotid stenosis (n=1), arteriovenous malformation (n=1), and cervical neurofibroma (n=1). There were 12 diagnostic angiograms and 13 interventional angiograms. The left transradial approach was chosen due to left vertebrobasilar pathology (n=22), right subclavian stenosis (n=2), and previous right arm amputation (n=1). There was one instance of radial artery spasm, which resolved after catheter removal, and one conversion to transfemoral access in an interventional case due to lack of distal catheter support. There were no procedural complications. Conclusions Left transradial access in diagnostic and interventional Cerebral Angiography is a technically feasible, safe, and an effective alternative when indicated, and may be preferable for situations in which pathology locations or anatomic limitations preclude right-sided radial access.
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transradial intraoperative Cerebral Angiography a multicenter case series and technical report
Journal of NeuroInterventional Surgery, 2020Co-Authors: Joshua W Osbun, Michael R Levitt, Bhuvic Patel, Alexander T Yahanda, Amar S Shah, Kathleen M Dlouhy, Joshua P Thatcher, Michael R Chicoine, Louis J Kim, Gregory J ZipfelAbstract:Background Use of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative Cerebral Angiography. Objective To report a multicenter experience on the use of radial artery access in intraoperative Cerebral Angiography, including case series and discussion of technical nuances. Methods 27 patients underwent attempted transradial Cerebral Angiography between May 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications. Results 24 of the 27 patients (88.8%) underwent successful transradial intraoperative Cerebral Angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication. Conclusions Transradial intraoperative Cerebral Angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.
Jacques E. Dion - One of the best experts on this subject based on the ideXlab platform.
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Arterial Dissections Complicating Cerebral Angiography and Cerebrovascular Interventions
AJNR. American journal of neuroradiology, 2000Co-Authors: Harry J. Cloft, Mary E. Jensen, David F. Kallmes, Jacques E. DionAbstract:BACKGROUND AND PURPOSE: Iatrogenic dissections are an uncommon complication of Cerebral Angiography. We retrospectively reviewed 12 cases of arterial dissections complicating Cerebral Angiography and cerebrovascular interventions to evaluate the clinical course of these dissections. METHODS: Cases from a large tertiary center performing a large number of neurovascular procedures were collected retrospectively. The patients’ medical records and imaging studies were reviewed, with particular attention given to the cause of the dissection, the development of ischemic events resulting from the dissection, and the treatment used. RESULTS: Each of nine dissections affected a vertebral artery, each of two affected an internal carotid artery, and one affected a common carotid artery. The prevalence of iatrogenic dissections was 0.4%. Seven of the dissections were noted at the time of contrast material injection for the filming of Cerebral angiograms. The other five dissections occurred during catheter or wire manipulations for interventional neuroradiologic procedures. Five of the patients in our series were treated with IV administered heparin for 24 to 48 hours. The other seven patients had recently suffered acute intracranial hemorrhage or undergone neurosurgery and could not undergo anticoagulant therapy. None of the patients developed symptoms of ischemia, but one was later found to have an asymptomatic infarct in the territory supplied by the dissected artery. CONCLUSION: Arterial dissections are an uncommon complication of Cerebral Angiography and cerebrovascular interventions and usually have a benign clinical course. Because Cerebral Angiography involves the placement of catheters and guidewires into the carotid and vertebral arteries, there is an inherent risk of arterial dissection. The carotid and vertebral arteries provide blood to the brain, and injury to them poses a risk of ischemic injury to the brain. Arterial dissections can cause ischemic symptoms by limiting flow secondary to severe stenosis or occlusion or by acting as a source of thromboembolism. We report a retrospective review of patients suffering iatrogenic carotid and vertebral artery dissections during Cerebral Angiography and cerebrovascular interventions. We evaluated the specific circumstances surrounding the occurrence of each dissection and the subsequent clinical course in each case.
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Risk of Cerebral Angiography in patients with subarachnoid hemorrhage, Cerebral aneurysm, and arteriovenous malformation: a meta-analysis.
Stroke, 1999Co-Authors: Harry J. Cloft, Gregory J. Joseph, Jacques E. DionAbstract:Background and Purpose—A well-defined complication rate of Cerebral Angiography in patients with subarachnoid hemorrhage (SAH), Cerebral aneurysm, and arteriovenous malformation (AVM) would be useful to physicians making decisions regarding the imaging of these patients. We sought to define a statistically significant complication rate through meta-analysis of prospective studies in the literature. Methods—Meta-analysis of 3 published prospective studies of complications in Cerebral Angiography was performed to specifically define the risk of Cerebral Angiography in patients presenting with SAH, Cerebral aneurysm, and AVM. The complication rates for Cerebral Angiography in patients with SAH and AVM/aneurysm without SAH were compared with the complication rates in patients who underwent Cerebral Angiography for transient ischemic attack (TIA)/ischemic stroke with use of the Fisher exact test. Results—The combined risk of permanent and transient neurological complication was significantly lower in patients ...
Gregory J Zipfel - One of the best experts on this subject based on the ideXlab platform.
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transradial intraoperative Cerebral Angiography a multicenter case series and technical report
Journal of NeuroInterventional Surgery, 2020Co-Authors: Joshua W Osbun, Michael R Levitt, Bhuvic Patel, Alexander T Yahanda, Amar S Shah, Kathleen M Dlouhy, Joshua P Thatcher, Michael R Chicoine, Louis J Kim, Gregory J ZipfelAbstract:Background Use of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative Cerebral Angiography. Objective To report a multicenter experience on the use of radial artery access in intraoperative Cerebral Angiography, including case series and discussion of technical nuances. Methods 27 patients underwent attempted transradial Cerebral Angiography between May 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications. Results 24 of the 27 patients (88.8%) underwent successful transradial intraoperative Cerebral Angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication. Conclusions Transradial intraoperative Cerebral Angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.