Background The transfemoral access (TFA) represents the traditional route for diagnostic cerebral angiography (DCA). Over the last decade, the transradial access (TRA) has been demonstrated as a safe and effective alternative to the TFA for DCAs and neuroendovascular procedures. Intraoperative cerebral angiography (IOA) is a useful adjunct in open cerebrovascular surgery. It mostly differs from a standard DCA in a non-neutrally positioned body with the head fixed in a skull-clamp, and impaired maneuverability and fluoroscopy due to the surgical setup. The effectivenss of both access routes for IOA require further characterization.

Methods All DCAs performed as a diagnostic adjunct in surgically positioned patients undergoing open cerebrovascular surgery in a hybrid room by dual-trained neurosurgeons were considered as IOA. Between 07/2020 and 03/2023, 133/2462 DCAs met inclusion criteria for IOA. After TFA and TRA access, a sheath angiogram was performed. Sheath-run-time to primary target-vessel-run-time (STT in minutes), amount of contrast dye (CD in milliliters), and fluoroscopy-time (FT in minutes) were analyzed. Comparisons were performed between TRA and TFA groups. Technically challenging catherizations (TCC) were defined by anatomical characteristics such as aortic arch type and supraaortic arterial tortuosity in conjunction with access site and target vessel.

Results A total of 133 patients were included. One case required transitioning from TRA to TFA (1/51, 2.0%) due to a minute radial vasculature. Eventually, the TRA (n=50) and TFA (n=83) were used for IOA. The TRA compared to the TFA was associated with a trend towards longer STT (6 mins, IQR 5-7, vs. 5 mins, IQR 3-7, p=0.067), less CD (40 ml, IQR 36 - 56, vs. 44 ml, IQR 36-56, p=0.034) and similar FT (4.0 mins, IQR 3.3-5.8, vs 4.0 mins, IQR 2.8-5.7, p=0.278). Technically challenging catheterizations (TCC) were encountered in 5/50 (10.0%) of TRA and 7/83 (8.4%) of TFA cases. Overall., TCC were associated with significantly longer STT (p=0.015), more CD (p=0.045) and longer FT (p=0.004). In the TFA group, there were no differences for STT (p=0.522), CD (p=0.385) and FT (p=0.182) among technically challenging catherizations. However, in the TRA group, TCC were associated with significantly longer STT (p<0.001), significantly more CD (p=0.036) and significantly longer FT (p=0.003). One groin hematoma (1/83, 1.2%) was observed in the TFA group. No other access-site related complications were encountered.

Conclusions In the setting of distinct anatomical features, the TRA appears to be more challenging than the TFA. Still, the TRA and TFA represent equally effective and safe routes for IOA. Tailoring the IOA access to the patient´s individual anatomy and the surgeon´s need facilitates short IOA times.

Disclosures M. Collins: None. C. Schirmer: None. G. Weiner: None. I. Melamed: None. O. Goren: None. P. Hendrix: None.