A retrospective study of single-center use of special radial catheters in the United States

Rist Guide Catheter for endovascular procedures: Initial Case Series From a Single Center

Sum up

Transradial approach (TRA) for intravascular surgery has gradually become a common approach in the field of neurological intervention. Compared with the femoral approach, the advantages of TRA include shallow surface and easy compression, no need for vascular closure, less bleeding, easy hemostasis, low incidence of complications at the access site, reduced postoperative pain, and no need to stay in bed after surgery. At present, transradial nerve intervention has become a hot topic in academic conferences all over the world. Foreign catheters specially designed for the radial artery have been marketed, and the safety and effectiveness of special catheters for the radial artery have been preliminarily explored.

The transradial approach (TRA) currently presents some challenges. For example, the radial artery is relatively small and has a tendency to develop vasospasm during interventional surgery. The transradial approach is currently achieved by using a catheter designed with a transfemoral approach.

In this paper, we analyze a series of cases using a special radial catheter to establish access, classify the causes of failure in specific cases, and discuss the effectiveness and limitations of the catheter.

Method

Patients who underwent transradial catheter (Rist) intervention between October 1, 2020 and December 1, 2021 were evaluated by recording the details of each treatment in terms of access establishment, reaching the target vessel location, completion of surgical objectives, and surgical complications. If, during the procedure, it is not necessary to switch to another puncture site or replace a different catheter, the establishment of the pathway is considered successful. If the surgeon can guide the radial catheter to the target vessel location during the operation, the performance in place is considered good.

A total of 78 patients were included in this study, with an average age of 60.3 years and 45 males (57.7%). The most common types of surgery are assisted embolization of intracranial aneurysms or angioplasty assisted by stents for narrowing of arteries or veins. (table1)

The preferred site was radial artery in 71 cases (91%), femoral artery in 4 cases (5.1%), target vessel in 48 cases (61.5%) on the right side, 28 cases (35.9%) on the left side, and bilateral artery in 2 cases (2.6%) (table2)

The following table shows the instrument selection during the procedure：

Ultrasound imaging guidance was used in all cases. The choice of access site was based on the radial artery diameter ≥1.8mm. If the radial artery is open and <1.8mm in diameter, the radial artery access is used. If the entry site must be switched to the femoral artery, the operation is still performed using the Rist system. The choice of a two-axis or three-axis system is based on surgical needs and operator preferences.

Result

The procedure was successfully completed in 77 patients (98.7%). The table below summarizes the technical difficulties and complications associated with access establishment and surgery in each case. Overall, five patients (6.4%) needed to switch from a radial-to-femoral approach.

In abnormal case 1, radiography revealed an anomaly in the middle cerebral artery that led to the termination of radial surgery. In abnormal case 2, the anterior and posterior views of the angiography showed that the radial access was difficult due to brachial artery curvature, requiring a switch to the transfemoral approach while preserving the radial catheter. (as shown below)

Sum up

From this study, we can see several aspects:

1, the use of this special radial catheter to establish access has a high surgical success rate (98.7%), indicating that it has good effectiveness.

2. In the establishment of access, only 24.3% of the triaxial system (puncture sheath + transradial catheter + intermediate catheter) was used, mainly for thrombolysis and arteriovenous malformations, while 75.7% of the biaxial system (puncture sheath + transradial catheter) was used to push the transradial catheter to the rocky and cavernous segments of the internal carotid artery to provide stable support. Therefore, it can be seen that the establishment of a biaxial system using a special transradial catheter can meet most surgical treatment needs.

3. The 7F transradial catheter is limited in thrombectomy. The 0.079-inch lumen only makes it compatible with the 5F aspiration catheter, which cannot provide high aspiration efficiency. However, the ultimate reason is that due to the limitation of the size of the radial artery, the requirements of thrombectomy can be met by exchanging the long sheath with a smaller external diameter.

The study does have limitations. It was a small series of experiments performed by experienced operators, and caution must be exercised when discussing and using the results.

Guiding Solo times are coming!

Domestic special catheter will be listed soon, please look forward to!