Despite several retrospective studies analyzing the safety and efficacy of transradial access (TRA) versus transfemoral access (TFA) for cerebral angiography, this transition for neurointerventional ...procedures has been gradual. Nonetheless, based on our positive initial institutional experience with TRA for mechanical thrombectomy in acute ischemic stroke patients, we have started transitioning more of our cerebral angiography cases to TRA. Here we present our single institution experience.
We performed a retrospective review of patients receiving TRA cerebral angiography at our institution between January 2016 and February 2017. We present our experience transitioning from TFA to TRA, including our criteria for patient selection, technical nuances, patient experience, complications, and operator learning curve.
We included 148 angiograms performed in 141 people by one of four operators. No major complications were observed, and the technical success of the procedures was consistent with those of TFA. Marked improvement in operator efficiency was achieved in a short number of cases during this transition when looking at operator proficiency as a function of angiograms performed and days of exposure to TRA (4.3 vs 3.6 min/vessel, P<0.05).
Safety and efficiency can be preserved while transitioning to TRA. While further investigation is necessary to support transition to TRA, these findings should call for a re-evaluation of the role of TRA in catheter cerebral angiography.
INTRODUCTION:
Flow diverting (FD) stents revolutionized the management of broad neck aneurysms. Several FD stents surface modifications have been developed over the last decade to reduce ...thromboembolic complications or enhance aneurysmal occlusion rates. Promoting FD endothelization through surface coating has emerged as a novel modality to enhance stent coverage, thus improving aneurysmal occlusion, reducing aneurysmal progression and post-treatment failure. Herein, we report our in vitro experience with FD surface modification using gelatin.
METHODS:
PED Flex stents were incubated overnight with either PBS (unmodified) or gelatin, followed by a three-hour incubation with human microvascular endothelial cells. Endothelial cell attachment and proliferation were assessed at various time points.
RESULTS:
There was a significant increase(p < 0.05) in endothelial cell attachment on gelatin(6.3 ± 2.1)surface modified stents compared to unmodified control stents. This increase in endothelial cells was maintained 14 days gelatin 6.3 ± 2.7, fold of control)following cell incubation but gradually decreased until it became insignificant by day 21. Next, we analyzed the temporal rate of endothelial stent coverage. Following cell incubation, 20% of surface-modified stents were coated by endothelial cells on day 5 compared to just 2% in unmodified stents. This difference in cell coverage remained significant (p < 0.05), with surface-modified stents being entirely covered by 2 weeks while unmodified stents were only 50% covered. We also observed a significant increase (p < 0.05, fold of unmodified) in endothelial cell migration onto (1.8 ± 0.2) and from (1.5 ± 0.033) gelatin-coated stents compared to unmodified controls.
CONCLUSIONS:
Our in vitro experience demonstrates that gelatin has the potential to enhance the endothelialization of FD, leading to increased aneurysm occlusion rates, thereby minimizing post-treatment failure. Further investigations are essential to fully evaluate this novel modality and compare it to the commercially available devices.
