Abstract 442: Transradial Access For Neurointerventional Procedures In The Elderly Population

Introduction/Purpose Transradial access (TRA) has been shown to be both efficacious and safe across a range of neuro‐interventional procedures. The elderly population represents a sub‐population in which the benefits of TRA could be magnified given their increased risk of access site complications. However, this population may be at higher risk for access site and procedural failure due to their increased likelihood of vessel tortuosity and vascular disease. The current neuro‐interventional literature is lacking with respect to the safety and efficacy of trans‐radial access in the elderly population. Materials/Methods A retrospective review of patients older than 80 years who underwent diagnostic cerebral angiogram or neuro‐endovascular intervention through proximal and distal radial access from 2018 to 2023 at a single center was conducted. Results The mean age of patients who underwent diagnostic cerebral angiogram (N= 35) and endovascular intervention (N= 31) were 82.5 and 83.5 years, respectively (ranges from 80 to 94). Vascular sheath diameters used in the diagnostic and intervention groups were 5 and 5 to 7 French, respectively. Amongst patients in both the diagnostic and intervention groups, proximal radial access was used in 8 and 16 patients, respectively, and distal radial access was used in 27 and 15 patients, respectively. One distal radial access failure occurred in the diagnostic group due to the small diameter of the radial artery. In addition, a patient was switched to femoral access due to the aberrant origin of the right subclavian artery. In the intervention group, there were 4 radial access failures due to difficult anatomy. In the first case, the patient's aortic arch anatomy and proximal left common carotid artery tortuosity prevented guide catheter placement into the left carotid artery. In the second case, the catheter could not be navigated due to proximal left common carotid artery tortuosity. In the third case, the benchmark guide catheter could not be advanced into the left common carotid artery due to significant angulation. In the fourth and final case, the complex radial artery loop could not be navigated. Total failure rates in the diagnostic and intervention groups were 5.7% and 15.2 %, respectively. No access site or other procedural complications were noted. Conclusion Neuro‐interventions are increasingly important concerning the aging population. The benefits of the trans‐radial approach have been well documented as safe and efficacious, with minimal access site complications. Our findings add to the literature, demonstrating that the trans‐radial approach is safe and effective for performing cerebral angiography and neuro‐interventions in octogenarian patients with acceptable crossover and no access site complications