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The radial nerve is the biggest branch of the posterior cord of the brachial plexus and one of its five terminal branches. Entrapment of the radial nerve at the elbow is the third most common compressive neuropathy of the upper limb after carpal tunnel and cubital tunnel syndromes. Because the incidence is relatively low and many agents can compress it along its whole course, entrapment of the radial nerve or its branches can pose a considerable clinical challenge. Several of these agents are related to normal or variant anatomy. The most common of the compressive neuropathies related to the radial nerve is the posterior interosseus nerve syndrome. Appropriate treatment requires familiarity with the anatomical traits influencing the presenting symptoms and the related prognoses. The aim of this study is to describe the compressive neuropathies of the radial nerve, emphasizing the anatomical perspective and highlighting the traps awaiting physicians evaluating these entrapments.

Background The relationship of the radial nerve is described with various osseous landmarks, but such relationships may be disturbed in the setting of humerus shaft fractures. Alternative landmarks would be helpful to more consistently and reliably allow the surgeon to locate the radial nerve during the posterior approach to the arm. Questions/purposes We investigated the relationship of the radial nerve with the apex of triceps aponeurosis, and describe a technique to locate the nerve. Materials and Methods We performed dissections of 10 cadavers and gathered surgical details of 60 patients (30 patients and 30 control patients) during the posterior approach of the humerus. We measured the distance of the radial nerve from the apex of the triceps aponeurosis along the long axis of the humerus in cadaveric dissections and patients. This distance was correlated with the height and arm length. For all patients, we recorded time until first observation of the radial nerve, blood loss, and postoperative radial nerve function. Results The mean distance of the radial nerve from the apex of the triceps aponeurosis was 2.5 cm, which correlated with the patients’ height and arm length. The mean time until the first observation of the radial nerve from beginning the skin incision was 6 minutes, as compared with 16 minutes in the control group. Mean blood loss was 188 mL and 237 mL, respectively. With the numbers available, we observed no difference in the incidence of patients with postoperative nerve palsy: none in the study group and three in the control group. Conclusion The apex of the triceps aponeurosis appears to be a useful anatomic landmark for localization of the radial nerve during the posterior approach to the humerus.

BackgroundThe purpose of this study is to determine if a standardized protocol for radial nerve handling during humeral shaft repair reduces the incidence of iatrogenic nerve palsy post operatively.MethodsSeventy-three patients were identified who underwent acute or reconstructive humeral shaft repair with radial nerve exploration as part of the primary procedure for either humeral shaft fracture or nonunion. All patients exhibited intact radial nerve function pre-operatively. A retrospective chart review and analysis identified patients who developed a secondary radial nerve palsy post-operatively. In each case, the radial nerve was identified and mobilized for protection, regardless of whether the implant necessitated the extensile exposure.ResultsFractures were classified according to AO/OTA guidelines and included 23 Type 12A, 11 Type 12B, and 3 Type 12C. Eight patients had periprosthetic fractures and 28 fractures could not be classified. All patients in the cohort were fixed with locking plates. Surgery was indicated for 36 patients with humeral nonunions and 37 patients with acute humeral shaft fractures. Of the 73 patients, 2 (2.7%) developed radial nerve palsy following surgery, one from the posterior approach and one from the anterolateral approach. Both patients exhibited complete recovery of radial nerve function by 6-month follow-up. No significant differences (p > 0.05) were found in any demographic or surgical details between those with and without radial nerve injury.ConclusionsNerve exploration identification and protection leads to a low incidence of transient radial nerve palsy compared to the rate reported in the current literature (2.7% compared to 6–24%). Thus, radial nerve exploration and mobilization should be considered when approaching the humeral shaft for acute fracture and nonunion repairs.Level of evidenceLevel III.

The radial artery approach is a Class I recommendation for coronary procedures in the ESC guidelines. However, there are no specific guidelines favoring either the right or left radial approach. Consequently, the choice of access remains at the discretion of the interventional cardiologist. Despite its potential advantages, the left radial approach is still underutilized by many operators. This one-year prospective non-randomized study included 100 patients undergoing percutaneous coronary procedures. Patients were divided into two groups; 52 underwent the right radial approach (RRA), and 48 underwent the left radial approach (LRA). The primary aim was to compare both approaches’ feasibility and potential procedural complications. The LRA group demonstrated significantly lower rates of radial artery spasm (8.3% vs. 44.2%, p < 0.001), radial artery tortuosity (2.1% vs. 23.1%, p = 0.002), and subclavian artery tortuosity (14.6% vs. 32.7%, p = 0.034) compared to the RRA group. Median radiation exposure time was significantly shorter in the LRA group (129.0 [87.75–246.5] seconds) compared to the RRA group (254.0 [161.0–469.5] seconds), p < 0.001. Patient comfort was significantly higher with the LRA (100% vs. 75%, p < 0.001). Among patients aged ≥ 65 years, LRA was associated with lower rates of spasm, tortuosity, and radiation exposure time. The left radial approach is a feasible and safe access route for percutaneous coronary interventions, offering notable advantages over the right radial approach, including reduced arterial spasm, lower tortuosity, shorter radiation exposure, and better patient comfort. Elderly patients particularly benefit from left radial access.

BackgroundInterventional cardiology produced level 1 evidence recommending radial artery-first for coronary angiography given lower vascular complications. Neuroendovascular surgeons have not widely adopted the transradial approach. This prospective, single center, non-inferiority comparative effectiveness study aims to compare the transradial and transfemoral approaches for diagnostic cerebral angiography with respect to efficacy, safety and patient satisfaction.MethodsConsecutive patients presenting for diagnostic cerebral angiography were selected to undergo right radial or femoral access based on date of presentation. Primary outcome was ability to answer the predefined diagnostic goal of the cerebral angiogram using the initial access site and was assessed with a non-inferiority design. Secondary outcomes included technical success per vessel, complications, procedure times and patient satisfaction.ResultsA total of 312 patients were enrolled, 158 and 154 for right radial and femoral access, respectively. The diagnostic goal of the angiogram was achieved in 152 of 154 (99%) patients who underwent attempted femoral access compared with 153 of 158 (97%) patients who underwent radial access, confirming non-inferiority of the transradial approach. Secondary outcomes showed equivalent technical success by vessel, no major complications, and similar frequency of minor complications between the two approaches. In-room time was similar between approaches, though post-procedure recovery room time was significantly shorter for transradial patients. Patient satisfaction results significantly favored the radial approach.ConclusionsIn patients undergoing diagnostic cerebral angiography, transfemoral and transradial access achieve procedural goals with similar effectiveness and safety, though patients strongly prefer the radial approach. Findings support consideration of adopting a radial-first strategy for diagnostic cerebral angiography.

Background and Objectives: Radial artery spasm (RAS) is a frequent complication during invasive angiography using the transradial approach, leading to patient discomfort and procedural challenges. While intra-arterial nitroglycerine (NTG) effectively reduces RAS after sheath insertion, preprocedural prevention strategies are limited. This study evaluates the efficacy of topical NTG in improving radial artery puncture success and reducing RAS incidence. Materials and Methods: In a randomized, double-blind single-center study 100 patients undergoing angiography were pretreated with either topical NTG or placebo. Outcomes assessed included RAS incidence, radial artery puncture success, number of attempts, procedural duration, patient discomfort, and complications. RAS was evaluated angiographically and clinically, with additional subgroup analyses for diabetic and smoking patients. Results: Topical NTG significantly reduced RAS incidence (53.2% vs. 73.6%; p = 0.0349) and increased radial puncture success on the first attempt (89.4% vs. 77.4%; p = 0.0488). Diabetic patients particularly benefited from NTG application, with lower RAS rates (36.4% vs. 76.2%; p = 0.0296). No significant differences were observed in procedural duration, patient discomfort, or complication rates between groups. The placebo group demonstrated a higher incidence of diffuse RAS (p = 0.0109). Conclusions: Preprocedural topical NTG application is a safe, non-invasive intervention that improves radial artery access success and reduces RAS, especially in high-risk subgroups such as diabetics. These findings support its potential as a procedural optimization tool in cardiovascular interventions, particularly in patients with heart failure, who often require repeated and reliable vascular access.

Radial glia is a cell type traditionally associated with the developing nervous system, particularly with the formation of cortical layers in the mammalian brain. Nonetheless, some of these cells, or closely related types, called radial glia-like cells are found in adult central nervous system structures, functioning as neurogenic progenitors in normal homeostatic maintenance and in response to injury. The heterogeneity of radial glia-like cells is nowadays being probed with molecular tools, primarily by the expression of specific genes that define cell types. Similar markers have identified radial glia-like cells in the nervous system of non-vertebrate organisms. In this review, we focus on adult radial glia-like cells in neurogenic processes during homeostasis and in response to injury. We highlight our results using a non-vertebrate model system, the echinoderm Holothuria glaberrima where we have described a radial glia-like cell that plays a prominent role in the regeneration of the holothurian central nervous system.

Carotid artery stenting through radial artery access is limited by the lack of dedicated neurovascular catheters and sheaths. Transradial access (TRA) is now widely used for carotid artery stenting [CAS]. Distal radial access in the snuff box (SB-TRA) offers an even more attractive option that lowers bleeding and occlusive complications than even conventional TRA. We report the use of a sheathless system for CAS using commonly available materials using a snuff box approach and distal radial access (SB-dTRA). Three patients underwent CAS of the right carotid artery using an SB-TRA approach. All three were completed satisfactorily without any procedural or access site complications. By using conventionally available dedicated neurovascular long sheaths, it is possible to perform CAS using the snuff box trans-radial route.

Objective To detail the neurovascular crossing patterns between the leash of Henry (LoH) and the deep branch of the radial nerve (DBRN) in supination and pronation of the forearm, using imaging methods with anatomic correlation. Materials and methods This cross-sectional study was performed ex vivo with HRUS and MRI with anatomic correlation on 6 samples and in vivo with HRUS with Doppler on 55 participants scanned bilaterally. The in vivo participants were enrolled over a 6-month period. The crossing patterns between the LoH and DBRN were assessed ex vivo and in vivo. Additional morphological features of the DBRN, LoH, and fat plane were assessed in vivo only. Biometric features of the participants were recorded. Statistical analyses were performed using Shapiro–Wilk, parametric and non-parametric tests. Results The most common neurovascular crossing pattern was the ascending branch of the radial recurrent artery (RRAab) crossing below (ex vivo: 83.3%, in vivo: 85.3%) and the muscular branch crossing above (ex vivo: 100%, in vivo: 63.2% %) the DBRN. Both the deep and superficial surfaces of the DBRN exhibited an intimate relationship with the vessels of the LoH. A positive correlation between vessel diameter and anthropometric factors was observed. In addition, the muscular branch exhibited a significantly smaller diameter than the RRAab. Conclusion Our study detailed the relationship between the LoH and the DBRN and highlighted the high incidence of vessel crossing above the DBRN at the level of the muscular branch. Knowledge of neurovascular crossings is crucial for understanding neurovascular entrapment syndromes and planning interventional procedures to reduce vascular complications.

Background Compared with conventional transradial access (TRA), distal radial access (DRA) is rarely used for percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and may be beneficial to prevent radial artery occlusion (RAO). We aimed to evaluate the incidence of RAO between DRA and TRA 24 h after primary PCI in patients with STEMI. Methods This is a single-center, open-label, prospective, randomized controlled trial conducted at Beijing Luhe Hospital, China, between January 2022 and July 2023. Five hundred and twenty patients (mean age: 61.3 ± 13.0 years; 81% male) with STEMI were randomly assigned to the DRA ( n  = 260) or TRA ( n  = 260) group. Primary PCI was performed using the radial artery access assigned study group. The primary endpoint was the rate of RAO assessed using Doppler ultrasound 24 h after primary PCI. Secondary outcomes included time taken for sheath insertion, access success rate, hemostasis time, fluoroscopy time, radiation dosage, and access-related complications. Results The incidence of RAO was significantly lower in the DRA group than that in the TRA group (1.9% vs. 8.5%, P  = 0.001). Access was successful in 94.6% of patients, and the crossover rate was 5.4% in both groups. The median time taken for sheath insertion was significantly longer (133 s vs. 114 s, P  = 0.009), whereas the mean hemostasis time was shorter (209 ± 71 min vs. 372 ± 70 min, P  < 0.001) in the DRA group. The incidence of modified Early Discharge After Transradial Stenting of Coronary Arteries (mEASY) ≥ II hematoma was lower in the DRA group (0.8% vs. 3.5%, P  = 0.033). However, there was no significant difference in fluoroscopy time, radiation dosage, or access-related complications. Conclusions In patients with STEMI undergoing primary PCI, compared with TRA, DRA prevented RAO 24 h postoperatively and was associated with shorter hemostasis time and a lower incidence of mEASY ≥ II hematoma. Trial registration Clinical Trials.gov Identifier: NCT05461781.