2024 American Academy of Neurology Abstract Website

Objective:

To describe a rare complication due to transradial access (TRA) for mechanical thrombectomy.

Background:

Recent advances support using neuroendovascular treatments for a wide variety of cerebrovascular diseases ranging from mechanical thrombectomy to treatment of cerebral vascular malformations. Transradial access (TRA) has risen in popularity and is reported to be superior to transfemoral access (TFA) as it is associated with shorter hospital stays, lower costs, less morbidity and mortality, and increased patient satisfaction. However, TRA is associated with potential complications, namely radial artery spasm (RAS), radial artery occlusion (RAO), pseudoaneurysm, extravasation, arteriovenous fistula, and hematoma. Here we report a less commonly anticipated complication, radial artery avulsion.

Design/Methods:

Case report

Results:

A 58-year-old woman with a history of prior stroke, cocaine use, and paroxysmal atrial fibrillation on apixaban underwent a mechanical thrombectomy for basilar artery occlusion. Due to the complexity of the patient's anatomy TRA was successful in achieving cerebral vascular access. She was successfully treated with basilar artery revascularization, although post-thrombectomy course was complicated by entrapment of radial access catheter and subsequent avulsion of the radial artery. Further manipulation of the catheter was not performed at the time. Overnight she was treated with transdermal and local administration of vasodilator agents and warm compress. To minimize further complications, vascular surgery removed the access catheter and reported a 4-5 cm segment of radial artery adherent to the catheter. No further complications, including limb/hand ischemia, were noted.

Conclusions:

TRA is associated with lower peri-procedural risks/complications. Increased understanding means we can now more accurately identify, treat, and prevent such outcomes. Commonly reported procedural modifications include switching to smaller diameter catheters, sheathless approach/using a guiding sheath, and pharmacological intervention including infiltrating the perivascular soft tissue with lidocaine and nitroglycerin. Such measures could potentially help to reduce the risk of vasospasm, vascular occlusion, and subsequent radial artery avulsion.