E-002 Transradial Approach for Pediatric Neurointerventions: A Case Series

Introduction/Purpose The Transradial approach (TRA) for Neurointerventional procedures has recently garnered interest as an alternative to the traditional transfemoral approach (TFA) in adult patients. While the benefits of the TRA have been well reported in adult patients, there are a paucity of reports in the literature regarding its use in the pediatric and adolescent populations. The paucity of literature regarding the TRA for Neurointerventional procedures in the pediatric population is likely due to fear of spasm in the narrow caliber radial artery as well as the perceived difficulty in navigating the cerebrovasculature through the TRA. At our institution we have implemented the radial first approach in most adult diagnostic and interventional cases. More recently, we have transitioned to the use of the TRA in pediatric patients as well. Here we present the first reported case series utilizing the TRA in the pediatric population, demonstrating its safety and efficacy for both diagnostic and neuro interventional procedures. Materials and methods We retrospectively collected data on patient undergoing trans radial intervention from July 2018 to Feb 2019. Pertinent details collected include demographics, indication, technique, radial artery diameter, and complications. Results We have 4 patients in pediatric population where radial approach was used. Indications included Juvenile Nasopharyngeal Angiofibroma embolization (2), right ICA pseudoaneurysm which failed medical management (1), and right cerebellar AVM (1). In all cases, a 6F sheath with a 6F ENVOY guide catheter (Codman- DePuy Synthes, Raynam, MA) were used. One patient developed radial artery vasospasm, and 5 mg verapamil were administered intraarterially post procedure before removal of sheath. The patient did not have any complaints post-procedurally. All preprocedural objectives were met, and none of the interventions required changing to a transfemoral approach. The radial artery remained patent in all 4 patients post-procedurally. Conclusion TRA is safe, effective, and well tolerated in appropriately selected pediatric population. Most importantly, the risk of bleeding and arterial damage, the most common complications following these procedures, is essentially eliminated with the Transradial approach. Ultrasound guided measurement of the artery to ensure caliber over 2 mm is recommended in this population to avoid complications. Disclosures N. Majmundar: None. P. Patel: None. V. Dodson: None. I. Bach: None. J. Liu: None. P. Khandelwal: None.