Stroke: Vascular and Interventional Neurology (Nov 2022)

Transradial Approach for Pediatric Diagnostic and Neurointerventional Surgery: Single‐Center Case Series and Systematic Review

  • Ammad A. Baig,
  • Jenna Neumaier,
  • Yusuf J. Hashmi,
  • Muhammad Waqas,
  • Justin M. Cappuzzo,
  • Andre Monteiro,
  • Hamid H. Rai,
  • Wasiq Khawar,
  • Kenneth V. Snyder,
  • Elad I. Levy,
  • Adnan H Siddiqui,
  • Renee M. Reynolds,
  • Jason M. Davies

DOI
https://doi.org/10.1161/SVIN.122.000411
Journal volume & issue
Vol. 2, no. 6

Abstract

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Background Recent widespread adoption of a transradial approach in adults has encouraged its use and expansion in children; however, the safety and feasibility of the transradial approach in the latter has not been established. We evaluated these characteristics in our pediatric case series and compared our results with those in the literature. Methods Our prospectively maintained database was retrospectively searched for consecutive patients ≤18 years of age who underwent diagnostic and interventional neuroangiography through the transradial approach. Patient demographics, indications for the procedure, use of ultrasound guidance, arterial size at the access site, intra‐ and postprocedure complications, and outcomes were recorded. For the literature review, systematic searches of PubMed, MEDLINE, and Embase databases were conducted using keywords with Boolean operators (“radial artery” AND “pediatric”) for studies published in English between January 2000 and September 2021. Continuous variables were reported as means or medians and respective standard deviations and interquartile ranges according to data normality. Categorical variables were reported as frequencies. Results Twenty‐one patients were included in our series (mean age, 16.6±2.23 years, range 9–17 years; male sex, 11 [52.4%]). The transradial approach was used for diagnostic angiography in 15 cases (71.4%) and intervention in 6 (28.6%). Ultrasound guidance was used and a “radial cocktail” (verapamil‐heparin‐nitroglycerin) was given in all cases. Mean radial artery access‐site diameter was 2.2±0.46 mm. Two cases (9.5%) required conversion to femoral access. Two patients (9.5%) suffered reversible vasospasm. No radial artery occlusion or permanent neurologic deficits were recorded. The systematic review showed results similar to ours for vasospasm rates (6.3% and 9.5%, respectively) and procedural outcomes (92% and 91%, respectively). [Correction added on November 8, 2022, after first online publication: In the preceding sentence, the value 7% was changed to 6.3%, and the value 93% was changed to 92%.] Conclusion Our results and the literature review demonstrate that the transradial approach is a safe and feasible option for pediatric patients. Routine use of ultrasound guidance, selection of appropriately sized catheters, and prophylactic use of vasodilators and antispasmodics can help ensure the success of the procedure and limit common access‐site complications.

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