Radiation exposure in transradial versus transfemoral access in endovascular treatment of intracranial aneurysms

OBJECTIVES: To compare radiation exposure between transradial (TRA) and transfemoral (TFA) access and identify treatment-related factors associated with radiation exposure in endovascular treatment of intracranial aneurysms. MATERIALS AND METHODS: ). In addition to access route (TRA vs. TFA), patient-related (e.g. age, gender, aneurysm location) and procedure-related (e.g., interventionalist, incidental vs. symptomatic, used device) characteristics were analyzed with regard to radiation exposure using uni- and multivariable linear regression analysis. RESULTS: A total of 209 patients (156 female, 53 male; median age 59 [51-68]) were analyzed. Median DAP was 72.2 (51.6-96.7). Multivariable linear regression analyses revealed that radiation exposure did not differ significantly between TRA and TFA (β = 8.13 [-3.79 to 20.01]; p = 0.18). Stent-assisted coiling (β = 55.82 [34.91-76.74]; p < .001) and female gender (β = -14.95 [-27.5 to -22.41]; p = 0.02) were associated with increased DAP. Further patient- and procedure-related variables were not significantly associated with radiation exposure. CONCLUSION: In this study, the choice between TRA and TFA had no significant impact on radiation exposure during endovascular aneurysm treatment. Stent-assisted coiling was independently associated with increased radiation exposure during endovascular treatment of intracranial aneurysms. KEY POINTS: Question Understanding and minimizing radiation exposure in endovascular aneurysm treatment is essential, as the increasing use of transradial access necessitates comparison with the established transfemoral route. Findings Radiation exposure did not differ between transradial and transfemoral access, while higher doses were independently associated with stent-assisted coiling procedures of increased complexity. Clinical relevance Our findings support the safety of transradial access regarding radiation exposure, allowing operators to select the most suitable access route based on patient anatomy and preference without increasing radiation risk.