Predictors of Transradial Cerebral Angiography Failure and Comparative Outcomes with Transfemoral Approach: A Single-Center, Five-Year Retrospective Study

Transradial cerebral angiography (TRCA) is increasingly favored over transfemoral (TFCA) due to lower complication rates and improved patient comfort, despite anatomical and procedural challenges. This study aimed to assess factors influencing TRCA failure and compare clinical outcomes between TRCA and TFCA in patients undergoing diagnostic cerebral angiography at a single institution. A retrospective review of 2,314 patients (TRCA n=1,843; TFCA n=471) undergoing cerebral angiography between April 2019 and February 2024 was conducted. TRCA and TRCA failure groups were compared based on demographic data, procedure duration, presence of aortic arch imaging, complications, and radial artery issues. TRCA was successful in 79.7% of cases, with 4.3% requiring conversion to TFCA. Main causes of failure were radial artery puncture failure (55%), severe tortuosity (17%), and stenosis (9%). Aortic arch imaging significantly increased TFCA selection (p <.001). Overall complication rates were similar between TRCA (0.6%, 14 patients) and TFCA (0.9%, 1 patient) (p=0.48), though 11 TRCA complications were symptomatic cerebral infarctions. Proximal large vessel abnormalities (identified in 1% of patients) led to TFCA in 96% of these cases. Multivariate analysis identified procedure time (OR 1.112, P < 0.0001) and radial artery issues as significant predictors of TRCA failure. TRCA holds promise as a standard approach in neurointervention, but proficiency in both TRCA and TFCA remains essential. Radial artery issues and prolonged procedure time are significant predictors of TRCA failure. Optimizing TRCA outcomes requires meticulous pre-procedural aortic arch evaluation, enhanced operator experience, and continuous technical refinements.