Decreased Incidence of Radial Artery Vasospasm Using a Distal Transradial Approach in Diagnostic Cerebral Angiography: A Comparison of 200 Consecutive Cases.

Background And Objectives: Radial artery vasospasm is a common complication of radial artery catheterization. During the implementation of distal transradial approach (dTRA), we observed a decreased incidence of radial artery vasospasm on radial artery angiography following access that was not well detailed in the literature. The purpose of this study was to characterize the phenomenon of radial artery vasospasm in the context of different radial artery access points for diagnostic cerebral angiography.

Methods: We retrospectively reviewed consecutive patients undergoing diagnostic cerebral angiography from September 2023 to March 2024. Hundred conventional transradial approach (cTRA) and 100 dTRA diagnostic cerebral angiograms were performed. Following sheath insertion, all angiographic runs were reviewed, and a classification scheme was used to detail radial artery vasospasm occurrence.

Results: Radial artery vasospasm was lower in the dTRA approach compared with the cTRA approach (P = .019). A change in radial artery diameter was noted in 47 (47%) patients in the cTRA group vs 28 (28%) patients in the dTRA group. Radial artery diameter distal to the sheath was smaller in the cTRA group (2.30 ± 0.41) compared with the dTRA group (2.42 ± 0.48) (P = .021). Patients with Grade II/III spasm were younger (58 years vs 62 years; P = .029) and had a higher percentage of females (77.3% vs 62.4%; P = .030). Grade II/III spasm patients had a higher percentage of the cTRA approach compared with the dTRA approach (62.7% vs 42.4%; P = .008). These procedures were significantly longer with Grade II/III procedure time of 18:00 minutes vs 15.59 minutes in the Grade I group. Number of vessels catheterized was not significantly different between groups (P = .262).

Conclusion: dTRA for diagnostic cerebral angiography is associated with a lower incidence of radial artery vasospasm compared with cTRA. Operators seeking to obviate radial artery vasospasm may consider using the dTRA approach for diagnostic cerebral angiography.