Transradial versus transfemoral arterial approach for cerebral angiography and the frequency of embolic events on diffusion weighted MRI

Abstract

BackgroundThe 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.MethodsWe prospective analyzed 200 consecutive adult DSAs performed from January 2021 to January 2022, at a single tertiary center.ResultsOf the 200 consecutive diagnostic cerebral angiograms, 52% 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.ConclusionsDespite 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.

Incidence, Clinical Significance, and Longitudinal Signal Characteristics of Ischemic Lesions Related to Diagnostic Cerebral Catheter Angiography

“…Mechanical vessel wall stress may play a more important role in lesion development. This is further strengthened by recent findings that DWI lesions are more frequent when a transradial versus a transfemoral approach is used [19].…”

Transradial Versus Transfemoral Intraoperative Cerebral Angiography for Open Cerebrovascular Surgery: Effectiveness, Safety, and Learning Curve

“…However, these DWI lesions did not translate to clinical significant strokes. 9 Similarly, significantly more microembolisms were observed with TRA for coronary interventions. [18][19][20] Although the role of DWI lesions remains unclear and is often considered asymptomatic by neurological evaluation, the impact of these lesions requires further exploration to evaluate potential long-term sequelae.…”

“…1,[3][4][5][6][7][8] The potential drawbacks of the TRA are an increased risk for clinically silent diffusion-weighted imaging lesions with undetermined clinical impact. 9 Intraoperative cerebral angiography (IOA) is a useful adjunct in open and hybrid cerebrovascular surgery. [10][11][12][13][14] Although principally equal to a diagnostic DCA, the markedly different settings, including the non-neutral head position in a head clamp, single-plane or C-arm use, and impaired maneuverability because of profuse surgical drapes and surgical instruments, distinguish the diagnostic standard DCA and IOA.…”

A new imaging classification for safer radial access visceral intervention of the liver and optimal case selection: A preliminary report

“…9,10 In contrast, recently, the risk of embolic events after diagnostic cerebral angiograms via TRA was reported, with the rate of at least one hyperintense focus on magnetic resonance imaging diffusion weighted imaging after the procedure being 17.5% in TRA and 5.2% in TFA. 11 However, interventional radiology (IVR) with TRA has remained unchanged as the current global trend, especially in the cardiovascular field. In contrast to the global trend, this information has made it difficult for Radial Access for Visceral Intervention (R.A.…”