Radial artery catheterization technique

All procedures are conducted using conscious sedation. The left wrist is positioned over the left groin to bring the access site closer to the operator standing on the right side. The left wrist is prepped and draped. The right wrist is positioned against the right hip of the patient in slight pronation and prepped and draped in the event that left radial access fails. Local lidocaine is administered in the left anatomic snuffbox, and the distal left radial artery is catheterized using ultrasound guidance via double wall puncture and Seldinger technique. If access at this site fails, the left radial artery is accessed at the wrist. Catheterization is achieved using a 5-French Prelude sheath. A mix of 2000 units of heparin, 5 mg of nicardipine, and 200 mcg of nitroglycerin is administered through the sheath. A radial run is then performed to evaluate the anatomy of the left radial artery. A 5-French Simmons 2 Penumbra catheter (Penumbra, Alameda, California, USA) is used to select the target vessels in its formed configuration in a similar fashion to right transradial angiography. After the procedure is complete, the sheath is removed and a radial artery compression device is applied (Figs. ​(Figs.1,1, ​,22 and ​and33).

Pictures depicting our standard setup for left transradial neuroangiography. (a) Note the position of the left hand over the left groin, and the right wrist is prepped and draped as well. (b) Ultrasound guidance is utilized. (c) The sheath in inserted through the distal transradial artery “Snuff box approach.” (d) Closure is performed with the Prelude Sync radial compression device.

(a) A left radial artery angiogram is always performed. (b) AP view showing the process of reforming the catheter by bouncing the wire off the aortic valve. Note that the natural course of the wire from the left subclavian artery is the ascending aorta which facilitates reforming the catheter.

(a) AP views showing catheterization of the left common carotid artery, (b) the right common carotid artery, (c) the right internal carotid artery, (d,e) and the right vertebral artery from a left transradial approach.