Transradial Access - A Predictive Model to Assess Radial Artery Diameter

Michael Brockman^1, , Jarren Adam², Cassandra De La Torre³, Lucas Achkarian⁴ and Robert Hanna⁵

¹Texas Tech University Health Sciences Center El Paso

²St. Joseph’s Medical Center-Stockton, California

³Adventist Health White Memorial

⁴Cornell University

⁵Banner Desert Medical Center

Cite this paper:
Michael Brockman, Jarren Adam, Cassandra De La Torre, Lucas Achkarian and Robert Hanna. Transradial Access - A Predictive Model to Assess Radial Artery Diameter. American Journal of Medicine Studies. 2022; 10(1):1-7. doi: 10.12691/ajms-10-1-1

Abstract

Purpose: Currently, the femoral artery is the most common vascular access site for interventional procedures. With medical instrument advancements and improved procedure techniques, the radial artery is becoming the preferred vascular access point for interventionalists due to decreased complication risks and improved recovery times. Although transradial procedures have improved clinical outcomes, additional, pre-interventional imaging is often required to assess the capacity of the smaller radial artery when comparing the femoral artery. This study explores an alternative, machine learning-based method to predict radial artery adequacy for interventional procedures without the need for additional, pre-intervention imaging. Materials and Methods: Whole human body computed tomography (CT) scans were collected from New Mexico’s Decedent Image Database. The inclusion criteria were decedents between the ages of 18 to 99, who died of natural causes, and had no identifiable decomposition. The decedent’s femoral artery diameter, sex assigned at birth, age, carcinogen exposure, smoking history, drinking history, substance usage, height, and weight were recorded. Using Horos Project DICOM viewer, the right femoral and right radial artery of each CT scan was measured. The resulting measurements were then passed through the Python 3.9 module, Scikit-Learn, to create a predictive random forest classifier. Results: Femoral and radial artery diameters were measured on 127 decadents. The predetermined threshold for radial artery usability diameter was 2.5 mm, which was based on guidance from Hobby et al’s publication, Transradial Access: A Comprehensive Review. The performed linear regression of femoral artery diameter explains 54.9% of the variability found in radial artery diameter. After one-thousand training iterations, the random forest classifier model achieved a mean testing accuracy of 85.71% in predicting if the radial artery equal to or greater than 2.5mm.

Keywords:
the presented study preliminarily suggests that femoral artery diameter and other parameters such as age height weight and smoking history can be used for training a random forest classifier model to assess radial artery diameter

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Treuting R. Minimally invasive orthopedic surgery: arthroscopy. Ochsner J. 2000; 2: 158-163.
[2]	Banta HD. Introduction. Minimally invasive therapy in five European countries: diffusion, effectiveness and cost-effectiveness. Health Policy. 1993; 23: 1-5.
[3]	Riskin DJ, Longaker MT, Gertner M, Krummel TM. Innovation in Surgery: A Historical Perspective. Ann Surg. 2006; 244: 686.
[4]	Pancholy S, Patel T, Sanghvi K, Thomas M, Patel T. Comparison of door-to-balloon times for primary PCI using transradial versus transfemoral approach. Catheterization and Cardiovascular Interventions. 2010. p. NA-NA.
[5]	Iezzi R, Pompili M, Posa A, Annicchiarico E, Garcovich M, Merlino B, et al. Transradial versus Transfemoral Access for Hepatic Chemoembolization: Intrapatient Prospective Single-Center Study. J Vasc Interv Radiol. 2017; 28: 1234-1239.
[6]	Fischman AM, Swinburne NC, Patel RS. A Technical Guide Describing the Use of Transradial Access Technique for Endovascular Interventions. Tech Vasc Interv Radiol. 2015; 18: 58-65.
[7]	Liu LB, Cedillo MA, Bishay V, Ranade M, Patel RS, Kim E, et al. Patient Experience and Preference in Transradial versus Transfemoral Access during Transarterial Radioembolization: A Randomized Single-Center Trial. J Vasc Interv Radiol. 2019; 30: 414-420.
[8]	Cooper CJ, El-Shiekh RA, Cohen DJ, Blaesing L, Burket MW, Basu A, et al. Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison. Am Heart J. 1999; 138: 430-436.
[9]	Satti SR, Vance AZ, Golwala SN, Eden T. Patient Preference for Transradial Access over Transfemoral Access for Cerebrovascular Procedures. J Vasc Interv Neurol. 2017; 9: 1-5.
[10]	Balaban Y, Akbaş MH, Akbaş ML, Özerdem A. Efficacy and Safety of “Coronary Artery Bypass Graft Angiography” with Right Transradial Access versus Left Transradial Access and Femoral Access: a Retrospective Comparative Study. Braz J Cardiovasc Surg. 2019; 34: 48-56.
[11]	Amro A, Mansoor K, Amro M, Hirzallah H, Sobeih A, Kusmic D, et al. Transradial Versus Transfemoral Approach for Coronary Angiography in Females with Prior Bypass Surgery. Cureus. 2020; 2: e6797.
[12]	Sweid A, Jabbour P. Intra-arterial chemotherapy for retinoblastoma: transradial and transfemoral approach. J Neurointerv Surg. 2020; 12: 828.
[13]	Bishay VL, Biederman DM, Ward TJ, van der Bom IMJ, Patel RS, Kim E, et al. Transradial Approach for Hepatic Radioembolization: Initial Results and Technique. AJR Am J Roentgenol. 2016; 207: 1112-1121.
[14]	Thakor AS, Alshammari MT, Liu DM, Chung J, Ho SGF, Legiehn GM, et al. Transradial Access for Interventional Radiology: Single-Centre Procedural and Clinical Outcome Analysis. Can Assoc Radiol J. 2017; 68: 318-327.
[15]	New Mexico Decedent Image Database - Welcome Home. [cited 1 May 2021]. Available: http://nmdid.unm.edu/.
[16]	Horos Project - Free DICOM Medical Image Viewer. [cited 1 May 2021]. Available: https://horosproject.org/.
[17]	Welcome to Python.org. [cited 1 May 2021]. Available: https://www.python.org/.
[18]	Jupyter and the future of IPython — IPython. [cited 1 May 2021]. Available: https://ipython.org/.
[19]	scikit-learn. [cited 1 May 2021]. Available: https://scikit-learn.org/stable/index.html.
[20]	Gautschi OP, Stienen MN, Corniola MV, Schaller K. [Minimal invasive surgery: historical review, current status and perspective]. Praxis. 2014; 103: 1323-1329.
[21]	Biondi A, Grosso G, Mistretta A, Marventano S, Toscano C, Drago F, et al. Laparoscopic vs . open approach for colorectal cancer: evolution over time of minimal invasive surgery. BMC Surg. 2013; 13: 1-6.
[22]	Aykan AÇ, Hatem E, Kalaycıoğlu E, Altıntaş Aykan D, Gökdeniz T, Arslan AO, et al. Prediction of radial artery diameter in candidates for transradial coronary angiography: Is occupation a factor? Turk Kardiyol Dern Ars. 2015; 43: 450-456.