J Korean Neurosurg Soc.  2025 Mar;68(2):113-126. 10.3340/jkns.2024.0152.

Transradial Approach for Neurovascular Interventions : A Literature Review

• Kim H
• Kim YW
• Lee HJ
• Choi SW
• Kim S
• Oh JS
• Im SH
• Choi JH
• Kim SR

• KMID: 2565270
• DOI: http://doi.org/10.3340/jkns.2024.0152

Abstract

The femoral artery is the preferred access route for neurointerventions. The transfemoral approach (TFA) offers advantages such as a large diameter and easy access. However, it also entails disadvantages such as patient discomfort and high risk of complications. Following the initial report of coronary angiography using the transradial approach (TRA) in 1989, cardiologists discovered the advantages of TRA over the TFA and gradually replaced it with the TRA. In 1997, Matsumoto et al. used the TRA for cerebral angiography and neurointervention. Thereafter, the adoption of TRA for neurointervention gradually increased and good outcomes were reported. However, despite these developments, the adoption rate of TRA is relatively low. We reviewed the relevant studies to increase the accessibility of TRA for neurointerventionists.

Keyword

Endovascular procedures; Radial artery; Radiography, interventional

Figure

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  Fig. 1. Summary of the challenges and advantages of transradial neurointervention.

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  Fig. 2. A : Angiography via the right radial artery. White arrowhead indicates the brachial artery. Black arrowhead shows the radial artery. Black arrow indicates the ulnar artery. White arrow indicates the common interosseous artery. Two white arrows indicate the recurrent ulnar artery and the two black arrows show the recurrent radial artery. B : Angiographic anatomy of the axillary artery with branches.

• 

  Fig. 3. General concept and room sep-up for transradial neurointervention. The right arm is positioned in 15° to 20° abduction on a removable radial board with a soft foam pad for patient comfort, and this positioning matches that of the patient’s groin in the transfemoral approach (TFA). Thus, the drapes and catheters can be kept similar to those used in TFA, which allows the operator to easily manipulate the wire and catheters in the same customary fashion as during the TFA. After placing the arm on the board, the wrist is placed in the supine position and slightly hyperextended by keeping a soft roll or folded sheet underneath for supporting the extended wrist. This brings the radial artery closer to the skin and provides gentle tension in the overlying skin, making it easier to puncture [33].

Reference

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