Snuff box radial access: A technical note on distal radial access for neuroendovascular procedures

Radial access has been used in the field of interventional cardiology for years and is associated with very low access site complication rates, decreased length of stays, and decreased hospital charges.[1] Transradial access was originally described in 1989 and has since been incorporated into a myriad of interventions.[2] Recently, radial access has become more prevalent in neuroendovascular procedures due to more pliable catheters and technological advances allowing for smaller diameter radial access to distal intracranial vasculature. Unlike interventional cardiology procedures, the arch and cervical vessels must be interrogated during neuroendovascular procedures which require longer, more trackable catheters.[3,4] Traditional radial artery access can typically accommodate up to 6‐French sheaths, and the arm is placed on an arm board in a supinated position. Micropuncture is then completed on the ventral radial artery just proximal to the hand. Benefits of radial access include patient satisfaction, immediate ambulation, and lower access site complication rates. One cost–benefit analysis noted 275 dollars savings per patient accessed radially instead of femorally.[5] From a surgeon’s perspective, traditional radial access with the patient’s hand and arm supinated on a lateral arm board can ergonomically feel different than transfemoral access and can require an operator to stand closer to the radiation source. Conventionally, radial access in neuroendovascular procedures was used primarily for posterior circulation access, rescue, or bailout access when transfemoral access could not be obtained.[6]