Transradial access for endovascular treatment of intracranial aneurysms: safety, feasibility, and outcomes in a retrospective single-center series

BACKGROUND: A study was undertaken to investigate the relationship between the vascular access route and the occurrence of diffusion-weighted imaging (DWI) lesions as well as puncture site complications in patients undergoing elective endovascular treatment (EVT) for cerebral aneurysms. METHODS: This retrospective single-center study included all consecutive patients who underwent elective EVT of unruptured cerebral aneurysms via transradial (TRA) or transfemoral (TFA) access between January 2024 and April 2025. Postprocedural MRI was assessed for new DWI lesions. Univariable and multivariable regression analysis was performed to identify predictors for DWI lesions. RESULTS: A total of 199 patients (50.3% TRA, 49.7% TFA) were included. New DWI lesions were detected in 53% of patients. There was no difference in the rates of silent or symptomatic DWI lesions between the two groups (60% vs 50%, P=0.15; and 5% vs 10%, P=0.19, respectively). In a multivariate regression analysis, higher age (aOR 1.04 per year, 95% CI 1.01 to 1.06, P=0.009), longer procedure time (aOR 1.01 per minute, 95% CI 1 to 1.02, P=0.023), and the use of adjunctive techniques such as stent- and balloon-assisted coiling (aOR 6.96, 95% CI 1.73 to 27.99, P=0.006) were independent predictors of postprocedural DWI lesions, while no association was found for the access route. Puncture site complications were comparable between TFA and TRA groups (TRA 3% vs TFA 8%, P=0.12). CONCLUSION: TRA is a safe and feasible alternative to TFA for elective EVT. The risk of postprocedural DWI lesions is primarily influenced by patient age and procedural complexity rather than access route. These findings support the use of TRA in appropriately selected patients, particularly when vascular anatomy or patient preference favors this approach.