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Transradial access for neurointerventions: management of access challenges and complications
  1. Marie-Christine Brunet1,
  2. Stephanie H Chen1,
  3. Eric C Peterson2
  1. 1 Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  2. 2 Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Marie-Christine Brunet; mcc.brunet{at}


Background Numerous large randomized trials have shown a significant morbidity and mortality benefit with the transradial approach (TRA) over the transfemoral approach (TFA) for endovascular procedures. However, this technique is routinely avoided or aborted due to unfamiliarity with the technique and the associated anatomical difficulties that may be faced in this approach. The objective of this review is to identify both the common and uncommon challenges that may be encountered during a transradial approach for cerebrovascular catheterization and to provide tips and tricks to overcome the transradial learning curve.

Method A careful review of the literature and of all our transradial cases was carried out to identify the common challenges and complications that are encountered when using TRA for diagnostic cerebral angiography and neurointerventions.

Results A stepwise approach is provided to prevent and manage common challenges including radial artery access failure, radial artery spasm, radial artery anomalies and tortuosity, radial artery occlusion, radial artery perforation and hematoma, subclavian tortuosity and anomalies, and catheter knots and kinks.

Conclusion The ability to recognize and navigate anatomical variations and complications unique to TRA will accelerate learning, decrease unnecessary morbidity and mortality, and further advance the neurovascular field.

  • angiography
  • technique
  • artery
  • catheter
  • complication

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  • Contributors M-CB, SHC, ECP: Substantial contributions to the conception or design of the work and the acquisition, analysis, and interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ECP: Stryker Neurovascular: Consultant; Penumbra: Consultant; RIST Neurovascular: Stockholder; Medtronic Neurovascular: Consultant; Cerenovus: Consultant.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.