This episode unpacks a letters-to-the-editor debate sparked by the MOSAIC study (a Japanese multi-center trial in JVIR) and turns it into a practical framework for reducing embolic stroke risk during transradial visceral and hepatic interventions. Of 55 patients who underwent transradial access, 9 (16.4%) showed silent brain infarction on post-procedure MRI.
- It's the Plaque, Not the Angle: Eight of nine stroke patients were over 70 (mean age 80). The letters argue calcified arch plaque, not subclavian angulation, is the real culprit, and propose a pre-procedural chest CT for patients over 70, defaulting to femoral if significant arch plaque is found.
- Time in the Arch Matters: Stroke cases averaged 9 minutes to reach the descending aorta versus 1 minute for non-stroke cases. The fix: minimize arch exchanges and favor a microcatheter/micro-guidewire combo with soft J-tip wires over angled hydrophilic ones.
- Rethinking Anticoagulation: ACT-guided heparin dosing is unreliable transradially, risking silent under-heparinization. The proposed alternative is a fixed protocol: 3,000–5,000 IU upfront, then 1,000 IU every 30 minutes, ignoring ACT entirely.
Tune in to learn how patient selection, wire technique, and a rethought anticoagulation strategy can keep silent strokes off your transradial cases.
This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field.
Iezzi R, Bilhim T, Pua U, et al. Radial access in interventional radiology and the risk of stroke: lessons learned. J Vasc Interv Radiol 2026; 37:108778. https://doi.org/10.1016/j.jvir.2026.108778
Koretsune Y, Sone M, Higashihara H. Authors' reply to "Radial access in IR and the risk of stroke: lessons learned." J Vasc Interv Radiol 2026; 37:108777. https://doi.org/10.1016/j.jvir.2026.108777