Need for radial-specific neuro catheters

INTERVIEW WITH:

Pr. Frédéric Clarençon, Interventional Neuroradiologist at Hôpital Pitié-Salpêtrière, Paris.

Recently, Dr. Jildaz Caroff spoke with Prof. Frédéric Clarençon about risk factors associated with radial procedures and ways to limit them. What follows is a resumé of their enlightening conversation.

What are some of the factors known to be associated with delayed radial artery occlusion (RAO) in transradial access procedures?
The factor known to be associated with delayed radial artery occlusion (RAO) in transradial procedures are:

the small size of the RA
the size of the device used (6F and over)
the absence of intra-arterial injection of heparin
the duration of the procedure
the need to catheterize the left ICA (maybe due more numerous maneuvers like torque)

In cases where RAO does occur after a transradial access procedure, what are some potential clinical consequences for the patient and how might these be managed?
Usually, RAOs are asymptomatic. Rarely, the patient may experience pain and edema of the forearm. According to our experience, none of these RAOs led to ischemia of the hand.

Compared to rates reported in cardiology literature, you observed a significantly higher incidence of RAO in your neurointerventional practice (8 times higher!). What do you believe may account for this difference?
In our opinion, this higher occlusion rate may be explained by the fact that:

the size of the guiding catheters/long sheets is bigger than in cardiology (6F to 8F in INR)
for neuro-interventions, more maneuvers are required for the catheterization of the supra-aortic trunks.

Based on the study's findings, what are some potential strategies that could be employed to reduce the incidence of RAO in patients undergoing neurointerventions?
The potential strategies may be:

reduce as much as possible the duration of the procedure
use dedicated bracelet for wrist compression
use, as much as possible, small size guiding catheters/long sheets
use guiding catheters/long sheets dedicated to the radial access, with outer hydrophilic coating.

What is your radial access set-up today?
We always inject 50 UI/kg of heparin through the radial sheet, even in patients under dual antiplatelet therapy.
We avoid using a 7F sheet for the use of RIST 7F catheter, and introduce it directly at the skin.
We systematically use a dedicated bracelet for the radial artery compression, no more than 2h30 (except when there still a bleeding from the puncture site).

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