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Case series
Transradial intraoperative cerebral angiography: a multicenter case series and technical report
  1. Joshua W Osbun1,
  2. Bhuvic Patel1,
  3. Michael R Levitt2,
  4. Alexander T Yahanda1,
  5. Amar Shah1,
  6. Kathleen M Dlouhy1,
  7. Joshua P Thatcher3,
  8. Michael R Chicoine1,
  9. Louis J Kim4,
  10. Gregory J Zipfel1
  1. 1 Department of Neurosurgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  2. 2 Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA
  3. 3 Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri, USA
  4. 4 Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Joshua W Osbun, Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO 63110, USA; josbun{at}


Background Use of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative cerebral angiography.

Objective To report a multicenter experience on the use of radial artery access in intraoperative cerebral angiography, including case series and discussion of technical nuances.

Methods 27 patients underwent attempted transradial cerebral angiography between

May 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications.

Results 24 of the 27 patients (88.8%) underwent successful transradial intraoperative cerebral angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication.

Conclusions Transradial intraoperative cerebral angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.

  • angiography
  • aneurysm
  • arteriovenous malformation
  • fistula
  • technique

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  • Contributors Each author has made (1) substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; (2) drafting the work or revising it critically for important intellectual content; (3) final approval of the version published; and (4) agrees 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. JWO and MRL have provided manuscript oversight and administrative support.

  • 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 JWO is a consultant for Microvention and Terumo and has an unrestricted educational grant from Microvention. MRL has grant funding from the NIH and American Heart Association, receives unrestricted educational grants from Stryker Neurovascular, Medtronic, and Volcano Phillips, and has equity interest in eLoupes. LJK receives grant funding from the NIH and has equity interest in SPI Surgical. MRC has an unrestricted educational grant from IMRIS. GJZ receives grant funding from the NIH.

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

  • Patient consent for publication Not required.