Background Cerebral angiography has long been established as the gold standard modality to diagnose and treat cerebral vascular pathologies. Conventionally, the trans-femoral approach has been well established in neuro-interventional community for such procedures. Recently, the trans-radial approach has become a common alternative given its safety profile and increased patient satisfaction compared to the transfemoral route. Both routes are associated with their respective associated costs and differences typically emerge based on patients’ anatomy, operator expertise, and occurrence of complications.

Objective In this study, we aim to compare and evaluate the overall costs of diagnostic cerebral angiography for both routes and shed light on individual equipment cost for each route.Methods: This a retrospective single-center study of 926 elective diagnostic angiograms performed between December 2019 and March 2022.

Results The study comprised of 314 and 612 angiograms done through the TF and TR routes respectively. Female patients were significantly higher in the TF cohort (79.3% vs 67.8%, p<.001), and most other demographic characteristics and baseline modified Rankin Scale score were comparable between both cohorts. Similarly, the number of devices used was comparable between both groups. The overall cost of patients utilizing the TR route was comparable to that of the TF route (12591.8$ ±19128 vs 12789.5$ ± 18424, p=.88). However, the median cost of catheters was significantly higher in TR group (55.2$ vs 12.4$, p=.03), while the median cost of closure devices (87$ vs 20.2$ p<.001), and sheaths (44.6$ ± 11.3 vs 41.1$ ± 3.1, p<.001) was significantly higher in the TF group.

Conclusion Overall, our study shows that the TR approach can be less a less expensive option for patients undergoing diagnostic cerebral angiograms, especially if complications occur. Future studies can corroborate our findings and potentially lead to the adoption of TR as a low-cost, efficient, gold-standard technique for cerebral angiography.

Costs (dollars) Associated with Trans-Radial Versus Trans-Femoral Access

Disclosures K. El Naamani: None. E. Atallah: None. A. Momin: None. P. Jain: None. A. Hunt: None. A. Sambangi: None. A. Carreras: None. O. El Fadel: None. M. Gooch: 2; C; Stryker. S. Tjoumakaris: 2; C; Microvention, Medtronic. H. Zarzour: None. R. Schmidt: None. N. Herial: None. R. Rosenwasser: None. P. Jabbour: 2; C; Microvention, Medtronic, Balt, Cerus Endovascular.