title: Radial access for cerebrovascular procedures: Case report and technical note.
abstract: BACKGROUND
  Advantages of radial access over brachial/axillary or femoral access have been well described for several decades and include decreased cost, patient preference, and decreased major access site complications. Despite these advantages, radial access is rarely employed or even considered for neurointerventional procedures. This attitude should be reconsidered given several recent large, randomized, controlled trials from the cardiovascular literature proving that radial access is associated with statistically lower costs, decreased incidence of myocardial infarctions, strokes, and even decreased mortality. Radial access is now considered the standard of care for percutaneous coronary interventions in most US centers. Although radial access has been described for neurovascular procedures in the past, overall experience is limited. The two major challenges are the unique anatomy required to access the cerebral vasculature given very acute angles between the arm and craniocervical vessels and limitations in available technology.
  
  
  METHODS
  We present a simplified approach to radial access for cerebrovascular procedures and provide a concise step-by-step approach for patient selection, ultrasound-guided single-wall access, recommended catheters/wires, and review of patent hemostasis. Additionally, we present a complex cerebrovascular intervention in which standard femoral access was unsuccessful, while radial access was quickly achieved to highlight the importance of familiarity with the radial approach for all neurointerventionalists.
  
  
  RESULTS
  We have found that the learning curve is not too steep and that the radial access approach can be adopted smoothly for a large percentage of diagnostic and interventional neuroradiologic procedures.
  
  
  CONCLUSIONS
  Radial access should be considered in all patients undergoing a cerebrovascular procedure.
authors.affiliation: Department of Neurointerventional Surgery, Christiana Care Health System, USA Ssatti@christianacare.org.
authors.forename: Sudhakar R
authors.initials: SR
authors.lastname: Satti
authors.affiliation: Department of Interventional Radiology (AZV), Christiana Care Health System, USA.
authors.forename: Ansar Z
authors.initials: AZ
authors.lastname: Vance
authors.affiliation: Department of Neurointerventional Surgery, Christiana Care Health System, USA.
authors.forename: Thinesh
authors.initials: T
authors.lastname: Sivapatham
mesh_terms: D020434:Abducens Nerve Diseases / Q000601:surgery; D000369:Aged, 80 and over; D002528:Cerebellar Neoplasms / Q000601:surgery; D002530:Cerebellopontine Angle / Q000601:surgery; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D018810:Magnetic Resonance Angiography; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D017534:Radial Artery / Q000000981:diagnostic imaging*; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Radial; angiography; intervention; technique