Background Diagnostic cerebral angiography is an essential tool for evaluating a broad range of cerebrovascular disease, including aneurysms, vascular malformations, and stroke. The transfemoral artery (TFA) approach has widely been adopted due to its technical familiarity and consistent success rates. However, the transradial artery (TRA) approach, first widely adopted in the interventional cardiology practice, has seen increasing use in neuroendovascular procedures for its favorable safety profile, reduced access site complications, and improved patient satisfaction. Despite its growing use, comparative neuroendovascular data remain limited, particularly with respect to radiation exposure and procedural efficiency. Objective To compare procedural outcomes, radiation exposure, complication rates, and clinical factors between TRA and TFA in diagnostic cerebral angiography. Methods A retrospective review was performed of 304 patients undergoing diagnostic cerebral angiography between 2018‐2023 (TRA n=154; TFA n=150). Baseline demographics, comorbidities, procedural metrics, and outcomes were extracted from the electronic medical record. Continuous variables were analyzed with Mann‐Whitney U testing and categorical data with Fisher's exact test. To account for differences in the number of vessels catheterized, fluoroscopy and procedure times were normalized per vessel. Quantile regression was used to identify predictors of normalized fluoroscopy time across the outcome distribution. Results Patients in the TFA group were older than those in the TRA group (59.0 vs. 55.5 years, p =0.026) and had a higher prevalence of prior vascular access (59.3% vs. 33.1%, p 0.99). On quantile regression, increasing age was independently associated with longer fluoroscopy time at the median (β=0.020 min/year, p =0.0002), while TFA access was associated with a 2.1‐minute reduction in fluoroscopy time per vessel ( p <0.0001). Other covariates were not consistently predictive across percentiles. Conclusions Both TRA and TFA are safe access routes for diagnostic cerebral angiography, with equivalent complication rates. TFA offers superior procedural efficiency with regards to fluoroscopy time and duration, while TRA may provide advantages in patient comfort, early mobilization, and reduced access‐site morbidity as demonstrated in prior studies. Our findings underscore that access choice should be individualized, balancing procedural efficiency with patient‐centered outcomes. Future prospective trials stratified by vascular anatomy are warranted to refine selection criteria and optimize neuroangiography practice. image
Oei et al. (Sat,) studied this question.