Updates in Radial Access for Neurointervention: Feasibility, Innovations, and Future Directions

Radial access has rapidly gained popularity in the neurointervention world, building on its proven success in cardiovascular procedures. Radial access is currently used for a variety of neurointervention procedures, such as diagnostic cerebral angiography, aneurysm embolization, and mechanical thrombectomy due to a proven strong safety profile, patient-preferred alternative to traditional femoral access, faster ambulation, and fewer access-site complications. Additionally, the radial approach has proven effective for navigating particularly challenging arches not suitable for the femoral approach, posterior circulation interventions, and select acute ischemic stroke thrombectomy cases. Advances in the radial access technique, such as the distal radial access approach in the anatomical snuffbox, development of specialized access catheters, long radial sheaths to mitigate spasm, and refined hemostasis techniques have improved its feasibility, broadened its applicability to be routinely used in neurointervention procedures, and increased its utilization in cases with challenging aortic arch anatomy. Meta-analyses have reported high technical success (around 97%) with low crossover (approximately 5%) and minimal complications. This review highlights the latest evidence on radial access in neurointervention, focusing on technical tips, appropriate patient selection, clinical applications, as well as complication management.