Transulnar approach as an alternative access site for neuroendovascular procedures.

Objective: This study aims to describe our experience and safety considerations associated with the use of the transulnar approach in neurointerventional procedures when radial access is not feasible.

Methods: A prospective exploratory analysis was conducted on 35 patients who underwent diagnostic or therapeutic neuroangiography via transulnar approach due to radial access limitations. Technical aspects of the transulnar approach, patient demographics, procedural details, and complications were documented. Statistical analysis was performed using SPSS Statistics software.

Results: Among the 35 procedures, the transulnar approach demonstrated a high success rate (97.14%), with only one procedural failure. Indications for transulnar access included larger ulnar artery caliber (46%), radial artery spasm (37%), severe tortuosity of the radial artery (17%), and other anatomical considerations. Complications were rare, with only two access-related complications observed: a type I hematoma and ulnar artery vasospasm. No major bleeding episodes occurred, highlighting the safety profile of transulnar access.

Conclusion: The transulnar approach represents a feasible alternative for neurointerventional procedures when radial access is not achievable. It offers high success rates and minimal complications, comparable to the radial approach. Anatomical considerations, safety profile, and patient preference support its consideration as a secondary option in neurointerventional practice. Further research and larger studies are warranted to validate its efficacy and safety in a broader patient population.