Feasibility and safety of transradial intraoperative angiography for neurosurgery: An institutional experience

Background: Transradial approach for neuroangiography is becoming increasingly popular because of the advantages demonstrated by interventional cardiology. Many advantages of radial access could be applied to intraoperative angiography.

Objective: To report our institutional experience with transradial and transulnar intraoperative angiography, and evaluate its safety and feasibility.

Methods: Intraoperative angiography through upper extremity vessels was attempted in 70 consecutive patients between April 2019 and December 2022. Data on patient characteristics and surgical indications, procedural variables, and complications were collected.

Results: Of the 70 patients who underwent intraoperative angiography, 58.6% were female, and the mean age was 52.9 ± 14.0 years. The reason for surgery was aneurysm clipping in 42 (60.0%) cases. In total, 55 patients (78.6%) were positioned supine, 13 (18.6%) prone, and two (2.9%) were positioned three-quarters prone. Access was attempted via the radial artery in 60 (85.7%) patients and the ulnar artery in 10 (14.3%) patients. The procedure was successful in 69 of 70 cases (98.6%), as one required conversion to transfemoral approach due to significant spasm in the proximal right radial artery. The median fluoroscopy time was 8 min. No procedure was aborted, and no patient experienced access-site or angiography-related complications. Intraoperative angiography altered the surgical management in 3 (4.3%) cases. Re-access for follow-up angiography was unsuccessful in three (13.6%) of 22 due to radial artery occlusion.

Conclusions: Our institutional experience supports that transradial and transulnar intraoperative angiography is safe and feasible during neurovascular procedures for various indications and positions.