Purpose The objective of this study was to assess the efficacy and safety of transradial access for diagnostic angiography and interventional neuroradiology procedures. Methods This was a retrospective analysis of a single-center experience based on 225 patients attended between August 2015 and October 2019, in which transradial access was used for diagnostic angiography and endovascular interventions. Ultrasound-guided access was done at the level of the forearm or anatomical or snuffbox (distal transradial access). Conventional forearm transradial access was done in 179 procedures (right, left and bilateral in 169, 5 and 5, respectively), while distal transradial access was done in 46 cases (41 right and 5 left). Primary outcome measures included successful catheterization, need to change access, or technical complications. Results In the group of 131 diagnostic angiographies, the technique success rate was 100% to target the right vertebral artery, 97% for the right internal carotid, 93.5% for the left internal carotid, 82% for the left vertebral artery, and 100% for both common and external carotid arteries. All patients were discharged within 2–4 h after the procedure. A total of 94 interventional procedures were performed, including aneurysms in 39 cases, stroke in 34, and other procedures (carotid stents, arteriovenous malformations, carotid-cavernous fistula) in the remaining 21. The overall technical success in both diagnostic angiographies and interventional procedures was 97.7%. In four cases of diagnostic angiography and in 1 intervention, it was necessary to switch from transradial access to transfemoral access. Three cases of hematoma related to the access site were recorded. Conclusions In our experience, transradial access is an alternative approach for diagnostic angiography and neuro-interventions.

BACKGROUND: Radial artery access for cerebral angiography is traditionally performed in the wrist. Distal transradial access in the anatomic snuffbox is an alternative with several advantages. PURPOSE: Our aim was to review the safety and efficacy of distal transradial access for diagnostic cerebral angiography and neurointerventions.DATA SOURCES: We performed a comprehensive search of the literature using PubMed, Scopus, and EMBASE. STUDY SELECTION:The study included all case series of at least 10 patients describing outcomes associated with distal transradial access for diagnostic cerebral angiography or a neurointervention.DATA ANALYSIS: Random-effects models were used to obtain pooled rates of procedural success and complications.DATA SYNTHESIS: A total of 7 studies comprising 348 (75.8%) diagnostic cerebral angiograms and 111 (24.2%) interventions met the inclusion criteria. The pooled success rate was 95% (95% CI, 91%-98%; I 2 ¼ 74.33). The pooled minor complication rate was 2% (95% CI, 1%-4%; I 2 ¼ 0. No major complications were reported. For diagnostic procedures, the combined mean fluoroscopy time was 13.53 [SD, 8.82] minutes and the mean contrast dose was 74.9 [SD, 35.6] mL. LIMITATIONS:A small number of studies met the inclusion criteria, all of them were retrospective, and none compared outcomes with proximal transradial or femoral access. CONCLUSIONS:Early experience with distal transradial access suggests that it is a safe and effective alternative to proximal radial and femoral access for performing diagnostic cerebral angiography and interventions. Additional studies are needed to establish its efficacy and compare it with other access sites.ABBREVIATIONS: dTRA ¼ distal transradial access; FT ¼ fluoroscopy time; pTRA ¼ proximal transradial access; RAO ¼ radial artery occlusion; TFA ¼ transfemoral access; TRA ¼ transradial access; US ¼ ultrasound N euroendovascular procedures have traditionally been performed using transfemoral access (TFA). Transradial access (TRA) recently gained popularity due to its lower rate of access site complications, quicker recovery time, and greater patient satisfaction. 1 However, TRA is not without complications, including radial artery occlusion (RAO), hematoma, vasospasm, pseudoaneurysm,

BACKGROUND AND PURPOSE SARS‐CoV‐2 causes multiorgan disease due to altered coagulability and microangiopathy. Patients may have an increased risk of cerebrovascular accidents (CVA). Our objective was to analyze clinical and neuroimaging characteristics of patients with ischemic CVA during the pandemic peak in our region, in order to identify atypical presentations. METHODS We performed a cross‐sectional analysis of patients admitted under code‐stroke protocol to our center with a final diagnosis of ischemic brain infarction. We analyzed the main imaging and demographic characteristics and reviewed neuroimaging for atypical presentations. RESULTS One‐hundred patients with confirmed ischemic CVA were included. Nineteen had positive polymerase chain reaction testing for SARS‐CoV‐2 on admission. These patients had a lower prevalence of proximal arterial occlusion on imaging, higher in‐hospital mortality, and worse baseline disability. No differences were identified in affected vascular territory, volume of infarction, initial CT stroke score, prevalence of hemorrhagic transformation, gender, age, cardiovascular risk factors, time to admission, symptom severity on entry, or decision to treat with thrombolysis or mechanical thrombectomy. Prevalence of COVID‐19 in our code‐stroke sample was higher than that for our province during this time period. CONCLUSION The COVID‐19 group had more in‐hospital mortality, less proximal arterial occlusion on CT or MR angiography, and lower baseline modified Rankin Scale score. We suggest a possibly higher proportion of microangiopathic involvement or undetected distal large‐vessel occlusion in the COVID‐19 stroke group. Excess mortality was explained by severe respiratory failure. Otherwise, stroke patients with COVID‐19 did not differ demographically or clinically from those without the illness.