• complication
• technique
• angiography

We read with interest the recently published article by Almallouhi et al.1 Truly, the transradial approach (TRA) for neuroendovascular procedures has taken the field by storm. In this paper, benchmark rates for complications are documented. A 0.6% minor complication rate is recorded without major complications. In 2203 TRAs, minor complications included a local forearm hematoma in 11 patients, radial artery dissection in one patient, a local infection in one patient, and a radial artery pseudoaneurysm in one patient. 6.9% of cases required conversion to the transfemoral route.

Over the last 2 years at our institution, TRA has become the access of choice for elective treatment of posterior circulation aneurysms or diagnostic procedures and retreatment of aneurysms evaluated from prior angiograms (via transfemoral). It is frequently used when the aortic arch is tortuous or femoral access is complicated. Over the last 6 months we have performed 17 TRAs for diagnosis and nine TRAs for intervention. As a point of comparison, 113 (59 diagnostic, 54 therapeutic) neurointerventional procedures were completed during that time period. We have attempted to incorporate as much of the published literature into our practice as we navigate the learning curve of this procedure.

Given that TRA allows similar capabilities and has better access complication rates than the transfemoral approach, all neuroendovascular surgeons should be competent with this approach. Cardiology is frequently mentioned as the control arm for complication rates with the RIVAL and MATRIX studies.2 3 …