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Correspondence on "Transradial versus transfemoral arterial approach for cerebral angiography and the frequency of embolic events on diffusion weighted MRI" by Carraro do Nascimento et al
  1. Philipp Hendrix1,2,
  2. Itay Melamed1,
  3. Christoph J Griessenauer3,
  4. Clemens M Schirmer1
  1. 1 Department of Neurosurgery, Geisinger, Wilkes-Barre, Pennsylvania, USA
  2. 2 Department of Neurosurgery, Saarland University Medical Center, Homburg, Germany
  3. 3 Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
  1. Correspondence to Dr Philipp Hendrix, Department of Neurosurgery, Geisinger, Wilkes-Barre, PA 18711, USA; hendrix.philipp{at}

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We read the article by Carraro do Nascimento et al with great interest and applaud the authors’ initiative in exploring mostly clinically silent microembolisms during cerebral angiography.1 Briefly, the authors randomized patients to transradial access (TRA) or transfemoral access (TFA) for diagnostic cerebral angiography (DCA) and evaluated the presence of MRI diffusion weighted imaging (DWI) lesions 2 hours after the procedure. They observed 17.5% and 5.2% DWI lesions with TRA and TFA, respectively. The methodology and outcome presentation is concise and sound. This study indicates that further debate on optimal access site selection may be necessary and might alleviate the increasing enthusiasm for TRA in neurointervention. We would like to point out different aspects that remain undetermined and deserve further attention in future studies.

First, the actual procedure time has not been specified. Access does not cause cerebral microembolism whereas repeated crossings of the arch and (failed) vessel (re-)selections do. Hence, a more defined procedure time related to the embolic risk potential should be considered—for example, the time between vascular access (sheath …

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  • Contributors PH: conception and design of the work, data collection and interpretation, drafting of the article, final approval of the version to be published. IM, CJG, CMS: data interpretation and critically revising of the article, final approval of the version to be published.

  • 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 None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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