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Transradial versus transfemoral approaches for diagnostic cerebral angiography: a prospective, single-center, non-inferiority comparative effectiveness study
  1. Jeremy G Stone1,
  2. Benjamin M Zussman1,
  3. Daniel A Tonetti1,
  4. Merritt Brown2,
  5. Shashvat M Desai3,
  6. Bradley A Gross1,
  7. Ashutosh Jadhav4,
  8. Tudor G Jovin5,
  9. Brian Jankowitz6
  1. 1 Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2 UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  3. 3 Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4 Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5 Neurology, Cooper University Hospital, Camden, New Jersey, USA
  6. 6 Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
  1. Correspondence to Dr Brian Jankowitz, Cooper Neurological Institute, Cooper University Hospital, Camden, NJ 08103, USA; jankowitz-brian{at}


Background Interventional 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.

Methods Consecutive 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.

Results A 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.

Conclusions In 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.

  • angiography
  • standards
  • techniques

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  • Twitter @DrJeremyStoneMD, @shashvatdesaiMD, @ashupjadhav

  • Contributors Study design: JS, BMZ, BJ. Drafting the article: JS. Acquisition of data/data analysis: JS, BMZ, DAT, MB/ JS, SMD. Reviewed and revised article before submission: all authors. Study supervision: BJ.

  • 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 BJ: Consultant: Medtronic, Stryker. MB: Investor: Penumbra, Inc. BAG: Consultant: Microvention. TGJ: Consultant: Stryker Neurovascular (PI DAWN-unpaid), Ownership Interest: Anaconda, Advisory Board/Investor; FreeOx Biotech, Advisory Board/Investor; Route92, Advisory Board/Investor; Blockade Medical, Consultant; Honoraria: Cerenovus.

  • Patient consent for publication Not required.

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

  • Data availability statement De-identified patient data are available from the authors upon reasonable request.