E-005 Transradial access in the pediatric population

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 is 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 neurointerventional procedures. Materials and methods N/A Results We retrospectively collected data on patients undergoing transradial intervention from July 2018 to Feb 2019. We have 4 pediatric patients in whom the TRA was used. Indications included JNA 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) was used. One patient developed radial artery vasospasm, and 5 mg verapamil was administered intraarterially post-procedure. The patient did not have any complaints post-procedurally. All preprocedural objectives were met, and none of the interventions required changing to the TFA. The radial artery remained patent in all 4 patients post-procedurally. Conclusion The TRA is safe, effective, and well tolerated in the pediatric population. Most importantly, the risk of bleeding and arterial damage, the most common complications following interventional procedures, is essentially eliminated with the TRA. 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. L. Tomycz: None. P. Khandelwal: None.