Content area
Full text
Correspondence to Dr Justin F Fraser, Neurological Surgery, University of Kentucky, Lexington, KY 40536, USA; [email protected]
Introduction
The expansion of indications for neurointerventional procedures, combined with the need to treat a diverse patient population (including patients with tortuous anatomy and peripheral arterial disease), has driven a need for broader access options.1–4 There is literature supporting various techniques and tools for vascular access in patients undergoing neurointerventional radiology. However, vascular access is a fundamental requirement for any endovascular specialty, not solely neurointerventional radiology. This includes interventional cardiology and interventional radiology. Thus we aimed to develop recommendations based on the compendium of access literature, including that from neurointerventional and other interventional specialties, especially where the neurointerventional literature is lacking and other specialties have reported best practices or prospective randomized data.
Literature search
The Standards and Guidelines Committee of the Society of NeuroInterventional Surgery (SNIS), a multidisciplinary society representing the leaders in the field of endovascular therapy for neurovascular disease, prepared this report from a comprehensive review of the currently available English language literature relating to the topic. A literature search using PubMed (US National Library of Medicine) and Ovid (Wolters Kluwer) databases was performed from 1980 to 2018, with these key words: transfemoral access, transradial access, transbrachial access, transcarotid access, direct carotid access, direct vertebral access, venous access, pediatric arterial access. References were also found through screening of review articles and textbook chapters. Studies published in languages other than English were excluded. Recommendations follow the American College of Cardiology/American Heart Association classification of recommendation/level of evidence, and definition of classes and levels of evidence used in the American Heart Association/American Stroke Association recommendations.5
General considerations
There are several general principles of transarterial access that are broadly applicable to all access sites. First, data support the use of real time ultrasound guidance in arterial access, particularly in difficult access cases. In complex cases, it has been shown to reduce the number of attempts to successful cannulation, time to access, inadvertent vessel puncture, and access site complications in prospective randomized trials across multiple access sites and patient populations compared with arterial access based on fluoroscopic guidance, arterial palpation, or surface anatomical landmarks.6 The use of micropuncture access (21 g) versus standard access (18 g) has...