title: Transradial access in acute ischemic stroke intervention.
abstract: OBJECTIVE
  To describe the feasibility and safety of transradial access (TRA) in the interventional management of acute ischemic stroke (AIS).
  
  
  METHODS
  A retrospective review of the local institutional AIS interventional databases of three tertiary academic centers was performed and the use of TRA identified.
  
  
  RESULTS
  TRA was attempted in 15 (1.5%) of 1001 patients; it was used in 12 cases due to transfemoral access (TFA) failure and in 3 as the primary strategy. The mean age was 72.3±8.6 and 46% were male. Baseline National Institutes of Health Stroke Scale score was 19.5±8.7, two patients (14%) received intravenous tissue plasminogen activator, and mean time from last known normal to intra-arterial therapy was 17.0±20.1 h. Five patients had anterior circulation occlusive disease and 10 had vertebrobasilar occlusions. TRA was effective in allowing clot engagement in 13 of 15 cases: one patient had a hypoplastic radial artery that precluded sheath advancement and one had chronic innominate artery occlusion that could not be crossed. Mean time to switch from TFA to TRA was 1.9±1.3 h and the mean time from radial puncture to reperfusion was 2.2±1.0 h. Modified Thrombolysis In Cerebral Infarction 2b-3 reperfusion via TRA was achieved in 9 of 15 patients (60%). No radial puncture site complications were noted. At 90 days, two patients (13%) had a good clinical outcome and seven (50%) had died.
  
  
  CONCLUSIONS
  Failure of TFA in the endovascular treatment of AIS is uncommon but leads to unacceptable delays in reperfusion and poor outcomes. Standardization of benchmarks for access switch could serve as a guide for neurointerventionalists. TRA is a valid approach for the endovascular treatment of AIS.
authors.affiliation: Departments of Neurology, Neurosurgery and Radiology, Emory University School of Medicine/Grady Memorial Hospital Marcus Stroke and Neuroscience Center, Atlanta, Georgia.
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.affiliation: Departments of Neurology, Neurosurgery and Radiology, Emory University School of Medicine/Grady Memorial Hospital Marcus Stroke and Neuroscience Center, Atlanta, Georgia.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: University of Miami Leonard M. Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Keith G
authors.initials: KG
authors.lastname: DeSousa
authors.affiliation: University of Miami Leonard M. Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Pafford
authors.affiliation: Asia Pacific Comprehensive Stroke Network, Pomona, California, USA.
authors.forename: Nazli
authors.initials: N
authors.lastname: Janjua
authors.affiliation: University of Miami Leonard M. Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Ramdas
authors.affiliation: University of Miami Leonard M. Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Peterson
authors.affiliation: University of Miami Leonard M. Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Mohamed Samy
authors.initials: MS
authors.lastname: Elhammady
authors.affiliation: University of Miami Leonard M. Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Angiography; Intervention; Stroke; Technique