TRUST Technique for Neurointervention: A Promising Alternative for Complex Cases


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Abstract

Background:Neurointervention via Transradial Access (TRA) is becoming increasingly popular as experience with this technique increases. However, approximately 8.6–10.3% of complex TRA cases are converted to femoral access due to a lack of support or radial artery spasm. This study aimed to assess the efficacy and safety of the TRUST (trans-radial coaxial catheter technique using a short sheath, Simmons catheter, and Tethys intermediate catheter) technique in interventional procedures via TRA.

Methods:This was a single-center retrospective analysis of 16 patients admitted to our institute between January 2023 to May 2023 to undergo endovascular interventions with the TRUST technique via the TRA.

Results:The mean age of the study population was 63.8 years, and 62.5% were male (10/16). The most common procedure was intracranial atherosclerotic stenosis (93.75%, 15/16). All procedures were performed successfully, and the most common procedures in our cohort were ballooning (50.0%, 8/16), stenting (18.75%, 3/16), and both procedures combined (31.25%, 1/16). All procedures were performed using the TRA, and the distal and proximal radial arteries were used for access in 31.35% (5/16) and 68.75% (11/16) of the cases, respectively. Technical success was achieved in all patients and most cases demonstrated mTICI ≥2b recanalization (93.75%, 15/16). In this case, no major access-site complications occurred.

Conclusion:The TRUST technique is technically safe and feasible and had a high technical success rate and low complication rate in our study. These results demonstrate that the TRUST technique is a promising alternative for patients undergoing complex neurointerventions.

About the authors

Xinzhao Jiang

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People's Hospital, Hangzhou Medical College)

Email: info@benthamscience.net

Peng Wang

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People's Hospital, Hangzhou Medical College)

Email: info@benthamscience.net

Fang Liu

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People's Hospital, Hangzhou Medical College)

Email: info@benthamscience.net

Huadong Wu

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People's Hospital, Hangzhou Medical College)

Email: info@benthamscience.net

Peng Jiang

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People's Hospital, Hangzhou Medical College)

Email: info@benthamscience.net

Ruozhen Yuan

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People's Hospital, Hangzhou Medical College)

Email: info@benthamscience.net

Sheng Zhang

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People's Hospital, Hangzhou Medical College)

Author for correspondence.
Email: info@benthamscience.net

Zongjie Shi

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People's Hospital, Hangzhou Medical College)

Author for correspondence.
Email: info@benthamscience.net

References

  1. Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn 1989; 16(1): 3-7. doi: 10.1002/ccd.1810160103 PMID: 2912567
  2. Mitchell MD, Hong JA, Lee BY, Umscheid CA, Bartsch SM, Don CW. Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention. Circ Cardiovasc Qual Outcomes 2012; 5(4): 454-62. doi: 10.1161/CIRCOUTCOMES.112.965269 PMID: 22740010
  3. Mann JT 3rd, Cubeddu MG, Schneider JE, Arrowood M. Right radial access for PTCA: A prospective study demonstrates reduced complications and hospital charges. J Invasive Cardiol 1996; 8 (Suppl D): 40D.
  4. Brueck M, Bandorski D, Kramer W, Wieczorek M, Höltgen R, Tillmanns H. A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. JACC Cardiovasc Interv 2009; 2(11): 1047-54. doi: 10.1016/j.jcin.2009.07.016 PMID: 19926042
  5. Caputo RP, Tremmel JA, Rao S, Gilchrist IC, Pyne C, Pancholy S, et al. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc Interv 2011; 78(6): 823-39.
  6. Wang YB, Fu XH, Wang XC, et al. Randomized comparison of radial versus femoral approach for patients with STEMI undergoing early PCI following intravenous thrombolysis. J Invasive Cardiol 2012; 24(8): 412-6. PMID: 22865313
  7. Mamas MA, Tosh J, Hulme W, et al. Health economic analysis of access site practice in england during changes in practice. Circ Cardiovasc Qual Outcomes 2018; 11(5): e004482. doi: 10.1161/CIRCOUTCOMES.117.004482 PMID: 29743163
  8. Valgimigli M, Gagnor A, Calabró P, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: A randomised multicentre trial. Lancet 2015; 385(9986): 2465-76. doi: 10.1016/S0140-6736(15)60292-6 PMID: 25791214
  9. Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, Anas El-Wegoud M, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Libr 2018; 2018(4): CD012318. doi: 10.1002/14651858.CD012318.pub2 PMID: 29665617
  10. Joshi KC, Beer-Furlan A, Crowley RW, Chen M, Munich SA. Transradial approach for neurointerventions: A systematic review of the literature. J Neurointerv Surg 2020; 12(9): 886-92. doi: 10.1136/neurintsurg-2019-015764 PMID: 32152185
  11. Jhand A, Atti V, Gwon Y, et al. Meta-analysis of transradial vs transfemoral access for percutaneous coronary intervention in patients with ST elevation myocardial infarction. Am J Cardiol 2021; 141: 23-30. doi: 10.1016/j.amjcard.2020.11.016 PMID: 33220324
  12. Li Y, Chen SH, Spiotta AM, et al. Lower complication rates associated with transradial versus transfemoral flow diverting stent placement. J Neurointerv Surg 2021; 13(1): 91-5. doi: 10.1136/neurintsurg-2020-015992 PMID: 32487766
  13. Cooper CJ, El-Shiekh RA, Cohen DJ, et al. Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison. Am Heart J 1999; 138(3): 430-6. doi: 10.1016/S0002-8703(99)70143-2 PMID: 10467191
  14. Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): A randomised, parallel group, multicentre trial. Lancet 2011; 377(9775): 1409-20. doi: 10.1016/S0140-6736(11)60404-2 PMID: 21470671
  15. Agostoni P, Biondi-Zoccai GGL, De Benedictis ML, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures. J Am Coll Cardiol 2004; 44(2): 349-56. doi: 10.1016/j.jacc.2004.04.034 PMID: 15261930
  16. Morsi RZ, Kothari SA, Thind S, et al. The Zoom RDL radial access system for neurointervention: An early single-center experience. J Neurointerv Surg 2023; jnis-2023-020153. doi: 10.1136/jnis-2023-020153 PMID: 37236781
  17. Abecassis IJ, Saini V, Crowley RW, et al. The Rist radial access system: a multicenter study of 152 patients. J Neurointerv Surg 2022; 14(4): 403-7. doi: 10.1136/neurintsurg-2021-017739 PMID: 34344694
  18. Das S, Ramesh S, Velagapudi L, Sweid A, Gooch R, Tjoumakaris S, et al. Adoption of the transradial approach for neurointerventions: A national survey of current practitioners. J Stroke Cerebrovasc Dis 2021; 30(3): 105589.
  19. Mason PJ, Shah B, Tamis-Holland JE, et al. An update on radial artery access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: A scientific statement from the american heart association. Circ Cardiovasc Interv 2018; 11(9): e000035. doi: 10.1161/HCV.0000000000000035 PMID: 30354598
  20. Pancholy SB, Sanghvi KA, Patel TM. Radial artery access technique evaluation trial: Randomized comparison of Seldinger versus modified Seldinger technique for arterial access for transradial catheterization. Catheter Cardiovasc Interv 2012; 20(2): 288-91.
  21. Kwok CS, Rashid M, Fraser D, Nolan J, Mamas M. Intra-arterial vasodilators to prevent radial artery spasm: A systematic review and pooled analysis of clinical studies. Cardiovasc Revasc Med 2015; 16(8): 484-90. doi: 10.1016/j.carrev.2015.08.008 PMID: 26365608
  22. Dossani RH, Waqas M, Tso MK, Cappuzzo JM, Popoola D, Snyder KV, et al. Endovascular management of radial artery loop for neuroangiography: Case series. Interv Neuroradiol 2021; 27(4): 566-70.
  23. Luther E, Burks J, Abecassis IJ, et al. Navigating radial artery loops in neurointerventions. J Neurointerv Surg 2021; 13(11): 1027-31. doi: 10.1136/neurintsurg-2020-016856 PMID: 33443135
  24. Hadley C, Srinivasan V, Burkhardt JK, et al. Forming the simmons catheter for cerebral angiography and neurointerventions via the transradial approach—techniques and operative videos. World Neurosurg 2021; 147: e351-3. doi: 10.1016/j.wneu.2020.12.054 PMID: 33346049
  25. Lin YH, Liu HM. Update on cerebral hyperperfusion syndrome. J Neurointerv Surg 2020; 12(8): 788-93. doi: 10.1136/neurintsurg-2019-015621 PMID: 32414892
  26. Chu YT, Lee KP, Chen CH, et al. Contrast-induced encephalopathy after endovascular thrombectomy for acute ischemic stroke. Stroke 2020; 51(12): 3756-9. doi: 10.1161/STROKEAHA.120.031518 PMID: 33121385
  27. Rathore S, Stables RH, Pauriah M, et al. Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: A randomized study. JACC Cardiovasc Interv 2010; 3(5): 475-83. doi: 10.1016/j.jcin.2010.03.009 PMID: 20488402
  28. Kühn AL, Singh J, de Macedo Rodrigues K, Massari F, Moholkar VM, Marwah SK, et al. Distal radial artery (Snuffbox) access for intracranial aneurysm treatment using the Woven endobridge (WEB) device. J Clin Neurosci 2020; 81: 310-5.
  29. Kühn AL, Singh J, Moholkar VM, Satti SR, Rodrigues KM, Massari F, et al. Distal radial artery (snuffbox) access for carotid artery stenting - Technical pearls and procedural set-up. Interv Neuroradiol 2021; 27(2): 241-8.
  30. Rentiya ZS, Kuhn AL, Hutnik R, Shazeeb MS, De Leacy RA, Goldman D, et al. Transradial access for cerebral angiography and neurointerventional procedures: A meta-analysis and systematic review. Interv Neuroradiol 2022.

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