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Original research
Transradial cerebral angiography becomes more efficient than transfemoral angiography: lessons from 500 consecutive angiograms
  1. D Andrew Wilkinson,
  2. Neil Majmundar,
  3. Joshua S Catapano,
  4. Vance L Fredrickson,
  5. Daniel D Cavalcanti,
  6. Jacob F Baranoski,
  7. Caleb Rutledge,
  8. Andrew F Ducruet,
  9. Felipe C Albuquerque
  1. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  1. Correspondence to Dr Felipe C Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA; neuropub{at}


Background Transradial arterial access (TRA) for cerebral diagnostic angiography is associated with fewer access site complications than transfemoral access (TFA). However, concerns about increased procedure time and radiation exposure with TRA may slow its adoption. Our objective was to measure TRA rates of success and fluoroscopy time per vessel after ‘radial-first’ adoption and to compare these rates to those obtained with TFA.

Methods We examined 500 consecutive cerebral angiograms on an intent-to-treat basis during the first full year of radial-first adoption, recording patient and procedural characteristics and outcomes.

Results Over a 9-month period at a single center, 457 of 500 angiograms (91.4%) were performed with intent-to-treat via TRA, and 431 cases (86.2%) were ultimately performed via TRA. One patient (0.2%) experienced a temporary neurologic deficit in the TRA group, and none (0%) did in the TFA group (p=0.80). The mean±SD fluoroscopy time per vessel decreased significantly from the first half of the study to the second half for TRA (5.0±3.8 vs 3.4±3.5 min/vessel; p<0.001), while TFA time remained unchanged (3.7±1.8 vs 3.5±1.4 min/vessel; p=0.69). The median fluoroscopy time per vessel for TRA became faster than that for TFA after 150 angiograms.

Conclusion Of 500 consecutive angiograms performed during the first full year of radial-first implementation, 86.2% were performed successfully using TRA. TRA efficiency exceeded that of TFA after 150 angiograms. Concerns about the length of procedure or radiation exposure should not be barriers to TRA adoption.

  • angiography
  • aneurysm
  • artery
  • catheter
  • technique

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  • Contributors All authors made substantial contributions to the conception or design of the work. DAW: study design, data collection, data analysis, manuscript editing and writing, and statistical analysis. NM: study design, data collection, manuscript editing and writing. JSC: data collection and manuscript editing. VLF: data collection and manuscript editing. DDC: data collection and manuscript editing. JFB: manuscript editing and data analysis. CR: data collection and manuscript editing. AFD: study design and manuscript editing. FCA: study design, manuscript editing, and guarantor.

  • 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 AFD is a consultant for Stryker (Kalamazoo, MI), Cerenovus (Johnson & Johnson, New Brunswick, NJ), Medtronic (Dublin, Ireland), Penumbra (Alameda, CA), and Koswire, Inc (Flowery Branch, GA); and serves on the editorial board of Journal of NeuroInterventional Surgery. FCA serves on the editorial board of Journal of NeuroInterventional Surgery.

  • 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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