Evaluation of Subcutaneous Puncture Site Cocktails for Distal Transradial Cerebral Angiography in Improving Puncture Success and Cannulation-Induced Vasospasm: A Single-Center Retrospective Study.

Objective: The distal transradial approach has been one of the options for endovascular neurointervention because of the low risk of puncture site complications. However, the conventional and distal transradial artery approaches frequently cause cannulation-induced vasospasms, which can usually be prevented by vasodilators. The aim was to evaluate the effects of local infiltration using a puncture site cocktail of lidocaine mixed with nitroglycerin on puncture success and vasospasm for distal transradial cerebral angiography.

Methods: A total of 85 consecutive patients who underwent cerebral angiography via distal radial artery puncture between February 2024 and December 2024 were included. Of these patients, 28 patients were excluded due to irregularities. The remaining 57 patients were eligible for this retrospective study and were divided into 2 groups: (1) underwent local anesthesia with 1% lidocaine (n = 23, Lidocaine group); and (2) puncture site cocktail of 1% lidocaine mixed with nitroglycerin (n = 34, Cocktail group). In both groups, patients' characteristics and procedure results were retrospectively assessed. In addition, in all patients, the correlation between the number of punctures and distal radial artery diameter, and the cutoff values of distal radial artery diameters after local anesthesia for 1st puncture success were also assessed.

Results: Patient background characteristics showed no significant differences between the groups. In the procedure results, the mean diameter of the distal radial artery before local anesthesia was significantly smaller in the Cocktail group (2.1 vs 1.7 mm, p <0.05). The mean dilatation rate of the distal radial artery was significantly greater in the Cocktail group than in the Lidocaine group (1.3 vs 1.1, p <0.05); thus, there was no difference in the mean diameter after local anesthesia. The 1st puncture success rate and the mean number of punctures were not significantly different between the 2 groups. The rate of cannulation-induced distal flow arrest was significantly lower in the Cocktail group (47.8% vs 20.6%, p <0.05). Puncture site complications and radial artery occlusions were not observed in either group. There was a negative correlation between distal radial artery diameter after local anesthesia and the number of punctures (r = -0.53, 95% CI: -0.69 to -0.31, p <0.001). The cutoff value for the diameter of the distal radial artery was 1.9 mm.

Conclusion: The puncture site cocktail significantly increases the diameter of the distal radial artery, which may be related to the reduction of cannulation-induced vasospasm without periprocedural complications in cases with a small-diameter distal radial artery.