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Original research
Transradial versus transfemoral arterial approach for cerebral angiography and the frequency of embolic events on diffusion weighted MRI
  1. Vinicius Carraro do Nascimento1,
  2. Laetitia de Villiers1,
  3. Ian Hughes2,
  4. Alexis Ford1,
  5. Cheryl Rapier1,
  6. Hal Rice1
  1. 1 Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
  2. 2 Office for Research Governance and Development, Gold Coast University Hospital, Southport, Queensland, Australia
  1. Correspondence to Dr Vinicius Carraro do Nascimento, Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, QLD 4215, Australia; vinicn{at}me.com

Abstract

Background The radial artery approach has become popular as a ‘radial first’ strategy for arterial access in neuroangiography and neurointerventions. Recent studies have shown that transradial arterial access (TRA) for cerebral angiography has been associated with reduced access site complication rates and improved patient satisfaction compared with transfemoral access (TFA). The goal of this study was to evaluate the presence of abnormal MRI diffusion weighted imaging (DWI) foci following DSA and correlate their frequency with TRA or TFA.

Methods We prospective analyzed 200 consecutive adult DSAs performed from January 2021 to January 2022, at a single tertiary center.

Results Of the 200 consecutive diagnostic cerebral angiograms, 51% were performed via TRA and 49% were performed via TFA. Of the TRA cerebral angiograms, 17.5% demonstrated at least one hyperintense focus on MRI DWI. Of the TFA procedures, 5.2% were considered positive. One patient (0.5%) in the TRA group experienced a minor neurologic deficit postoperatively that had not completely resolved at 90 days after the procedure and no neurologic deficits occurred in the TFA group.

Conclusions Despite the proven benefit of TRA over TFA in neurointervention, the number of MRI DWI restriction foci were significantly more frequent during cerebral angiography when TRA was selected. Although the number of clinically symptomatic events were minimal, the widespread use of the technique may become clinically relevant. Further studies contrasting the TRA and TFA techniques will be beneficial for cerebral angiography.

  • Angiography
  • Intervention
  • MRI

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @carrarovini

  • Correction notice Since being published online, the sentence in the abstract ' Of the 200 consecutive diagnostic cerebral angiograms, 52% were performed via TRA' has been updated so that the percentage 52 has been corrected to 51.

  • Contributors VCN, LDV, IH, AF, and CR designed the data collection tools, monitored the data collection for the whole study, wrote the statistical analysis plan, cleaned and analyzed the data, and drafted and revised the paper. VCN and IH analyzed the data, and drafted and revised the paper. IH wrote the statistical analysis plan, monitored the data collection for the whole trial, and revised the draft paper. HR analyzed the data and revised the draft paper. VCN was responsible for the overall content as the 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 None declared.

  • Provenance and peer review Not commissioned; externally 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.