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Incorporation of transradial approach in neuroendovascular procedures: defining benchmarks for rates of complications and conversion to femoral access
  1. Eyad Almallouhi1,
  2. Sami Al Kasab1,2,
  3. Mithun G Sattur2,
  4. Jonathan Lena2,
  5. Pascal M Jabbour3,
  6. Ahmad Sweid3,
  7. Nohra Chalouhi3,
  8. M Reid Gooch3,
  9. Robert M Starke4,
  10. Eric C Peterson4,
  11. Dileep R Yavagal5,
  12. Stephanie H Chen4,
  13. Yangchun Li4,
  14. Bradley A Gross6,
  15. Daniel A Tonetti6,
  16. Benjamin M Zussman6,
  17. Jeremy G Stone6,
  18. Ashutosh P Jadhav7,
  19. Brian T Jankowitz8,
  20. Christopher C Young9,
  21. Do H Lim9,
  22. Michael R Levitt10,
  23. Joshua W Osbun11,
  24. Alejandro M Spiotta2
  1. 1 Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2 Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3 Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
  4. 4 Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  5. 5 Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
  6. 6 Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  7. 7 Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  8. 8 Neurosurgery, Cooper Neurological Institute, Camden, New Jersey, USA
  9. 9 Neurological Surgery, University of Washington, Seattle, Washington, USA
  10. 10 Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA
  11. 11 Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  1. Correspondence to Dr Alejandro M Spiotta, Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA; spiotta{at}


Background The transradial approach (TRA) has gained increasing popularity for neuroendovascular procedures. However, the experience with TRA in neuroangiography is still in early stages in most centers, and the safety and feasibility of this approach have not been well established. The purpose of this study is to report the safety and feasibility of TRA for neuroendovascular procedures.

Methods We reviewed charts from six institutions in the USA to include consecutive patients who underwent diagnostic or interventional neuroendovascular procedures through TRA from July 2018 to July 2019. Collected data included baseline characteristics, procedural variables, complications, and whether there was a crossover to transfemoral access.

Results A total of 2203 patients were included in the study (age 56.1±15.2, 60.8% women). Of these, 1697 (77%) patients underwent diagnostic procedures and 506 (23%) underwent interventional procedures. Successfully completed procedures included aneurysm coiling (n=97), flow diversion (n=89), stent-assisted coiling (n=57), balloon-assisted coiling (n=19), and stroke thrombectomy (n=76). Crossover to femoral access was required in 114 (5.2%). There were no major complications related to the radial access site. Minor complications related to access site were seen in 14 (0.6%) patients.

Conclusion In this early stage of transforming to the ‘radial-first’ approach for neuroendovascular procedures, TRA was safe with low complication rates for both diagnostic and interventional procedures. A wide range of procedures were completed successfully using TRA.

  • aneurysm
  • angiography
  • arteriovenous malformation
  • balloon
  • device

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  • EA and SAK are joint first authors.

  • Twitter @PascalJabbourMD, @Starke_neurosurgery, @ashupjadhav, @alex_spiotta

  • Contributors All authors have: provided a substantial contribution to the conception and design of the studies and/or the acquisition and/or the analysis of the data and/or the interpretation of the data. They have drafted the work or revised it for significant intellectual content and approved the final version of the manuscript. They agree to be accountable for all aspects of the work, including its accuracy and integrity.

  • 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.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request. Additional data from this project can be acquired by contacting the ‎corresponding author.‎

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