Transradial access for neurointerventions: a technical note with illustrative clinical cases

Background. The transfemoral approach has traditionally been the standard vascular access route for diagnostic and therapeutic neuroendovascular procedures. However, unfavorable iliofemoral anatomy, severe aortoiliac disease, complex aortic arch configurations, and access-site limitations may render transfemoral catheterization technically challenging or unsuccessful. The transradial approach, widely adopted in interventional cardiology, has emerged as an alternative access strategy in neurointerventions. Objective. To describe the technical aspects and practical considerations of transradial approach in neurointerventional procedures in a technical note with an illustrative case cases. Methods. This technical note with illustrative clinical cases describes practical aspects of transradial neurointervention, with emphasis on patient and access selection, vascular anatomy assessment, procedural planning, puncture techniques, catheter navigation, vasospasm prevention, equipment selection, hemostasis, and complication management. Case presentation. Four illustrative cases were selected to demonstrate the use of transradial approach as either a primary access route or a rescue strategy after technically difficult or unsuccessful transfemoral approach. The presented cases included carotid artery stenting for severe internal carotid artery stenosis, vertebral artery stenting, and endovascular embolization of a paraclinoid aneurysm. In three cases, transfemoral access was technically difficult or unsuccessful because of unfavorable vascular anatomy, including a type III aortic arch and aortoiliac occlusive disease, and transradial approach was subsequently used as an alternative access route. In one patient with obesity, transradial approach was selected as the primary access route because of the anticipated increased risk of femoral access-site complications. Conclusion. Transradial approach was technically feasible for completing the planned neurointerventional procedures in these four selected cases, both as a primary access strategy and as a rescue route after technically difficult or unsuccessful transfemoral approach. Careful patient selection, assessment of vascular anatomy, appropriate equipment selection, and familiarity with radial-specific techniques are important for successful implementation.