Abstract P508: Transradial Cerebral Angiography Becomes More Efficient Than Transfemoral; Lessons From 500 Consecutive Angiograms

Introduction: Transradial arterial access (TRA) for cerebral diagnostic angiography (DSA) is associated with reduced access-site complications compared with transfemoral access (TFA), though concerns about increased procedure time and radiation exposure may slow its adoption. Objective: To examine “radial-first” cerebral angiography by measuring TRA rates of success and fluoroscopy time and comparing to TFA. Methods: We examined 500 consecutive cerebral angiograms during the first full year of “radial-first” adoption, recording patient and procedural characteristics including intended and performed access sites, fluoroscopy time per vessel catheterized, and outcomes of the procedure. Results: Of 500 angiograms done over a nine-month period at a single center, 431 (86.2%) of cases were successfully performed via TRA. There was one case of temporary neurologic deficit in the TRA group, and none in the TFA group (n=1, 0.2% TRA vs. n=0, 0.05 TFA, p=0.8). Vascular access-site complications were lower in the TRA group than TFA (n=2, 0.4% TRA vs. n=2, 4.7% TFA, p=0.04). There was no difference in the number of cases successfully performed via TRA in the first half of the study compared with the second (n=215, 86.0% vs. n=216, 86.4%, p=0.90). Fluoroscopy time decreased from the first half of the study to the second half for TRA performance(5.0±3.9 min/vessel vs. 3.4±3.5 min/vessel, p Conclusions: Among angiograms performed during the first full year of “radial first” implementation, 86% were performed successfully using TRA. TRA efficiency continued to improve beyond the initial learning curve, exceeding that of TFA after 150 angiograms. Concerns about length of procedure or radiation exposure should not be barriers to TRA adoption.