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Vascular neurology
Transradial versus transfemoral access for diagnostic cerebral angiography: frequency of acute MRI findings in 500 consecutive patients at a single center
  1. Vinicius Carraro do Nascimento1,
  2. Laetitia de Villiers1,
  3. Permesh Singh Dhillon2,
  4. Luis Domitrovic3,
  5. Genevieve Sesnan1,
  6. Jean-Philippe Leblanc1,
  7. Louise Ninnes1,
  8. Ian Hughes4,
  9. Hal Rice1
  1. 1Department of Interventional Neuroradiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
  2. 2Department of Interventional Neuroradiology, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
  3. 3Department of Interventional Neuroradiology, Liverpool Hospital, Liverpool, New South Wales, Australia
  4. 4Office 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, Gold Coast, Queensland, Australia; vinicn{at}me.com

Abstract

Background The frequency of clinically symptomatic and asymptomatic diffusion-weighted imaging (DWI) hyperintense lesions and their correlation with the transradial artery (TRA) approach is unclear.

Objective To assess the frequency of abnormal diffusion restriction foci on DWI following cerebral angiography (digital subtraction angiography (DSA)) with the TRA or transfemoral artery (TFA) approach and identify predictors of DWI restriction foci.

Methods We analysed data from consecutive diagnostic cerebral angiograms obtained between January 2021 and October 2023 at a single tertiary center. MRI DWI was performed 2 hours after DSA. Patients underwent neurological assessment periprocedurally, as well as prior to discharge.

Results 500 patients were analysed; 277 (55%) procedures were performed via TRA and 223 (45%) via TFA. Overall, 74 (14.8%) patients had abnormal findings in the postprocedure MRI DWI. A higher incidence of positive DWI findings was noted in the TRA group, with 46 (16.6%) patients, compared with 28 (12.6%) in the TFA group (P=0.21). Symptomatic events occurred in seven (2.5%) of the TRA group and in two (0.9%) of the TFA cohort (P=0.31). At 60 days, the neurological deficit rate was one (0.4%) for the TRA group and one (0.4%) for the TFA group. Procedure time was the only significant predictor of DWI restriction (OR=1.04 per minute; P=0.0001).

Conclusion Although there were more symptomatic or asymptomatic embolic events with TRA than with the TFA approach following elective cerebral angiography, this was not significantly different. We recommend the choice of vascular access based on patient anatomy and characteristics, aimed at improving care through enhanced safety.

  • aneurysm
  • angiography
  • MRI
  • embolic

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2024-021472

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @carrarovini, @PermeshSD

    • Contributors VCdN, PSD, LD drafted the paper and collected data. IH and PSD analysed data. All authors participated in data collection. HR and LDV critically reviewed the report and approved the final version. VCdN is the guarantor, acceptign full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • 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.

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