Abnormal DW-MRI foci “significantly more frequent” with radial versus femoral access

Vinicius Carraro do Nascimento

A prospective analysis of 200 consecutive diagnostic cerebral angiograms has indicated that the number of diffusion-weighted magnetic resonance imaging (DW-MRI) restriction foci was “significantly more frequent” when transradial access was used—as compared to the more established transfemoral access approach.

As per a recent publication from Vinicius Carraro do Nascimento (Gold Coast University Hospital, Southport, Australia) and colleagues in the Journal of NeuroInterventional Surgery (JNIS), the occurrence of clinically symptomatic events within in this analysis was minimal. However, the authors note that the increasingly widespread use of radial access may lead to this becoming more clinically relevant in the future.

Carraro do Nascimento and colleagues begin their report by stating that the aforementioned approach has grown in popularity in recent times, with a ‘radial first’ access strategy via the radial artery being used in both neuroangiography and neurointerventions.

“Recent studies have shown that transradial arterial access for cerebral angiography has been associated with reduced access site complication rates and improved patient satisfaction compared with transfemoral access,” they write. “The goal of this study was to evaluate the presence of abnormal [DW-MRI] foci following DSA [digital subtraction angiography] and correlate their frequency with transradial access or transfemoral access.”

As such, they prospectively analysed 200 consecutive adult DSAs, performed from January 2021 to January 2022, at a single tertiary centre. Of these 200 consecutive diagnostic cerebral angiograms, 51% were performed via transradial access and 49% were performed via transfemoral access.

Some 17.5% of the transradial access angiograms demonstrated at least one hyperintense focus on DW-MRI, Nascimento and colleagues report. Meanwhile, of the transfemoral access procedures, 5.2% were considered positive. One patient (0.5%) in the transradial access 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 transfemoral access group.

“Despite the proven benefit of transradial access over transfemoral access in neurointervention, the number of [DW-MRI] restriction foci were significantly more frequent during cerebral angiography when [the former] was selected,” they authors conclude. In their JNIS report, Carraro do Nascimento and colleagues also posit that further studies contrasting these two main access techniques “will be beneficial” for cerebral angiography.

“This study raises a degree of awareness to the fact that a transradial approach may carry a very small but definite risk of neurological complications,” said Carraro do Nascimento, discussing the wider implications of the study with NeuroNews. “By no means are we against the technique. In fact, at our institution, transradial access is used in a significant number of cases. Most of our elective cerebral angiograms and a significant number of elective cases are performed via radial access. The important factors of our study are that there is no perfect/risk-free approach in neurointervention; and a radial approach can be seen as an alternative, rather than ‘radial only’, for neurointerventions. We are in the process of expanding our data, with the aim to publish the results of a larger cohort.”


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