Introduction Intraoperative angiography (IOA) is an essential tool for neurosurgery to confirm aneurysm occlusion, parent vessel patency, and effects of other cerebrovascular surgeries. Although the transradial approach for neuroangiography is becoming more popular, it has not been thoroughly studied for IOA. Therefore, we aimed to evaluate the safety and feasibility of transradial IOA in various indications.

Methods We conducted a retrospective study at our academic institution on consecutive patients aged 18 years or older who underwent IOA between April 2019 and December 2022 with attempted vascular access to the upper extremity. Data were collected on patient characteristics and surgical indications, procedural variables, and complications.

Results Seventy consecutive patients were included. The mean age was 52.9 ± 14.0 years, 58.6% were female, 15.7% were current smokers, and the median body mass index was 27.6. Access was attempted via the radial artery in 60 (85.7%) patients [52/60 (74.3%) right arm, 29/60 (41.4%) distal transradial approach] and the ulnar artery in 14.3% of patients [3/10 (30.0%) right arm]. Of these patients, 60.0% had aneurysm clipping, 20.0% AVM resection, 15.7% dAVF resection, 2.9% decompression for bow hunter syndrome, 1.4% meningioma resection, and 1.4% bypass surgery for Moyamoya disease. Patients were positioned supine in 78.6% of cases, prone in 18.6%, and three-quarters prone in 2.9%. The procedure was successful in 98.6% of cases, as one required conversion to femoral access due to significant spasm in the proximal right radial artery. No procedure was aborted, and no patient experienced angiography-related or access-site complications. The median fluoroscopy time was 8 (5.4-11.4) minutes. IOA changed the surgical management in 3 (4.3%) cases. Re-access for follow-up angiography was unsuccessful in three (13.6%) of 22 cases due to radial artery occlusion.

Conclusion Our findings support that transradial IOA is a safe and feasible alternative to femoral access in various neurosurgical indications and positions.

Disclosures G. Sioutas: None. M. Salem: None. N. Muhammad: None. D. Romeo: None. A. Corral Tarbay: None. Y. Kim: None. J. Sussman: None. J. Ng: None. I. Rhodes: None. A. Gajjar: None. E. Zager: None. V. Srinivasan: None. J. Burkhardt: None. B. Jankowitz: None. O. Choudhri: None.