Trans-Ulnar Artery Access for Neurovascular Procedures: Safety and Feasibility Study

Introduction While the trans‐radial artery (TRA) access becomes a more popular approach for interventional neurovascular procedures due to better patient satisfaction and fewer complications, there is very little data about the trans‐ulnar artery (TUA) approach in the neurointerventional field. This study investigates the safety and feasibility of TUA in neurointervention. Methods A retrospective, observational cohort study of adult patients that underwent cerebral angiogram in a tertiary medical center between 01/2019‐08/2025 was performed. Patients were stratified into two groups: TUA versus TRA. Indications for TUA included small caliber (< 1.5mm) and/or minimal pulsation and/or difficult anatomy of the radial artery. Propensity matched cohorts adjusted for age, gender, and procedure types (diagnostic vs interventional) were compared using multivariable regressions. The primary endpoint was a composite of major cerebrovascular events (requiring > 48hrs hospitalization), cross‐over to another arterial access site, major focal hematoma (> 10cm) and rate of symptomatic arterial occlusion during hospital stay. Secondary endpoints were procedure time (total time with fluoroscopy) and total contrast use. Results Overall, 434 patients were included (mean age, 61.35 ± 15.7, 69.8% female). TUA approach was performed in 217 patients (mean age, 61.87 ± 15.3, 70.5% female) with 120 diagnostic angiograms (55.3%) and 97 interventions. A cohort of 217 cases with TRA; 112 diagnostic (51.6%) and 69.5% female was matched as control group. Non‐significant trend towards more moderate sedation was provided in the TUA (n=64) than in the TRA (n=51) group and less general anesthesia in TUA (n=102) than in the TRA (129) group (OR =0.979, 95% confidence interval 0.762‐1.323). More major cerebrovascular events were reported in the TRA (n=6) compared to the TUA (n=2) group. Three cases crossed from TRA to TUA. No major hematoma or symptomatic occlusion was noticed. No significant difference was found in the procedure time or contrast use between the groups; TUA (12.8 ± 10.6) vs TRA (12.7 ± 12.6) and TUA (74.37 ± 44.5) vs TRA (77.95 ± 45.3), respectively. Conclusion TUA is a safe and feasible alternative arterial access approach in neurointervention when TRA is not possible. It can be effectively utilized for diagnostic cerebral angiography and a wide range of neurointerventional procedures.