For neurointerventional radiology procedures, arterial access is critical. The femoral artery has long been the go-to access point. But, say doctors at Marcus Neuroscience Institute at Boca Raton Regional Hospital, a part of Baptist Health South Florida, radial access may be better for many patients.
This thinking — based on decades of cardiovascular research on the use of the radial access site — is driving a change in how Institute physicians evaluate arterial access for each case.
Brian Snelling, M.D.
“Data from tens of thousands of patients has shown, time and time again, that the radial access site is better,” says Brian Snelling, M.D., chief of endovascular and cerebrovascular neurosurgery and director of the stroke program at Marcus Neuroscience Institute. “Because the majority of procedures that we offer endovascularly can be done from the wrist, we’re now looking to incorporate radial access into each case as a first line approach.”
Dr. Snelling says patient safety is a major factor in the Institute’s shift toward radial artery access.
“Twenty to 25 years ago, the field of interventional cardiology started looking at using the radial artery as an alternative to the femoral artery for coronary procedures,” Dr. Snelling says. “In that time, they’ve built a mountain of level one evidence — prospective data, randomized trials —showing that when you use the artery in the wrist, it's safer. Patients have better outcomes.”
More specifically, Dr. Snelling says, studies have shown a reduced chance of bleeding and other access site complications when using the radial artery versus the femoral artery.
Patient satisfaction is another important factor in Marcus Neuroscience Institute’s move toward radial access use. Patient satisfiers include improved comfort, reduced pain and faster recovery.
Despite the move toward increased radial access use, Dr. Snelling says each case requires a personalized evaluation.
“When speed or catheter size is an issue, like in the case of stroke thrombectomy, femoral artery access is likely to remain standard,” Dr. Snelling says. “But many elective cases, whether angiography, aneurysm treatments or carotid stenting, can be done radially.”
Even then, there will be differences in some of the specifics of the procedure, including the medications used to prevent radial arterial spasm (RAS).
Dr. Snelling recently contributed to an Endovascular Today article outlining his preferred radial access “cocktail” to prevent RAS.
“Endovascular therapy covers a whole range of medical sub-specialties — from neuro to cardiac to peripheral to vascular surgery,” Dr. Snelling says. “We may use the same access site, but we all have our own ways to modify a procedure. You have to take the evidence that's out there, and then you have to incorporate that into the clinical scenario that you're in.”
Part of Baptist Health South Florida, Marcus Neuroscience Institute serves patients across Palm Beach County and is an innovative nexus for neurologic and neurosurgical care. The Institute embraces a multidisciplinary approach to patient care — from non-surgical treatments and minimally invasive procedures to complex brain and spine surgery.
To refer a patient to Marcus Neuroscience Institute, call 561-955-4600.
