Comprehensive Analysis of Neurologic Complications Following Transradial Cerebral Angiography

Background and purpose: Transradial access (TRA) for cerebral angiography has become more popular due to fewer complications and greater patient comfort compared to transfemoral access. However, the frequency and nature of neurologic complications linked to TRA remain unclear. This study aimed to determine the incidence of symptomatic neurologic complications after transradial cerebral angiography, identify risk factors, and characterize clinical and imaging features of these complications.

Materials and methods: We retrospectively analyzed 1,679 consecutive cases of transradial cerebral angiography from a single institution between January 2018 and December 2020. Neurologic complications were defined as any symptomatic changes confirmed by diffusion-weighted imaging revealing ischemic lesions. A case-control matching method was used to enhance the reliability of the results. Clinical, procedural, and anatomical factors were examined for predictors of neurologic complications.

Results: Neurologic complications occurred in 1.0% (n=19) of cases, with 85% occurring within six hours post-procedure. No significant predictors of neurologic complications could be identified among the clinical, procedural, or anatomical factors assessed. Overall, 58% of patients experienced transient or reversible complications. Patients with permanent symptoms had mild to moderate disability (mRS scores of 1 or 2), with no severe disability (mRS score ≥3). Diffusion-weighted imaging commonly showed multifocal cortical or subcortical ischemic patterns, typically affecting the right middle cerebral artery territory or multiple territories, suggesting embolic mechanisms as a potential cause.

Conclusions: Neurologic complications following transradial cerebral angiography were rare but occurred early in the post-procedural period. The observed ischemic patterns, particularly the right-sided predominance, suggest embolic mechanisms as a potential cause. However, further large-scale, multicenter prospective studies are essential to identify risk factors more clearly and enhance patient safety in this increasingly utilized transradial approach.

Abbreviations: ACA＝ anterior cerebral artery; ICAS＝ intracranial atherosclerotic stenosis; PCA＝ posterior cerebral artery; SCA＝ subclavian artery; TFA＝ transfemoral access; TRA＝ Transradial access; VAO＝ vertebral artery orifice; VBA＝ vertebrobasilar artery.