Safety and Feasibility of Transradial Access for Neurointervention Procedures in Patients With Radial Artery Occlusion

BACKGROUND Transradial access (TRA) has proven advantages in interventional cardiology and neurointervention. There is limited literature detailing radial artery occlusion (RAO) recanalization, and generally, RAO necessitates alternate access. The purpose of this study was to evaluate the safety and feasibility of TRA in patients with RAO, allowing successful completion of the intended neurointervention procedure. METHODS AND RESULTS Prospectively maintained databases at 2 Australian high‐volume neurointervention centers between January 2019 and February 2022 were reviewed. All consecutive patients with RAO who underwent attempted TRA for diagnostic neuroangiography or neurointervention procedures were included. Sixty‐one attempts at TRA through RAO for neurointervention procedures were performed in 42 patients. The mean age was 54.9 years, and 65.6% were women. Fifty‐three cases (86%) successfully completed the intended neurointervention procedure following RAO recanalization: 33 cases of diagnostic cerebral angiography, 9 cases of cerebral vasospasms, 6 cases of aneurysm repairs, 3 cases of endovascular thrombectomies, 1 case of carotid artery stenting/angioplasty, and 1 case of intracranial dural arteriovenous fistula embolization. Six cases (9.8%) required conversion to alternate access to complete the procedure because of failed TRA or anatomical challenges to select the target vessel. Two cases (3.2%) experienced transient minor radial artery extravasation without clinical sequelae. No major complications were encountered. CONCLUSIONS TRA in patients with RAO for neurointervention procedures is both safe and feasible, with no significant additional equipment or cost. RAO is not a contraindication to radial artery access in neurointervention.