Feasibility of the distal transradial approach with an 8-Fr balloon guide catheter for neurointerventional procedures

Objective The distal transradial approach (dTRA) may reduce puncture-site complication rates compared with the conventional transradial approach (cTRA). However, the treatment outcomes of dTRA performed with large-bore catheters and the factors associated with procedural success remain unclear. We report the treatment outcomes of neurointerventional therapy performed via dTRA with a sheathless 8-Fr balloon guide catheter (BGC) and identify factors associated with procedural failure. Methods We retrospectively reviewed 51 consecutive patients who underwent neurointerventional therapy via dTRA with a sheathless 8-Fr BGC at our institution between April 2023 and March 2025. The primary endpoint was the procedural success rate. The secondary endpoint was the rate of puncture-site-related complications. We also analyzed factors associated with crossover from dTRA to cTRA or to a transfemoral approach (TFA). Results Procedural success was achieved in 42 of the 51 patients (82.4%). Crossover to cTRA was required in 5 cases (9.8%), and to TFA in 4 cases (7.8%). Patients requiring crossover to cTRA were significantly older than those who completed the procedure via dTRA ( p = 0.02). Acute ischemic stroke ( p < 0.01) and use of local anesthesia with light sedation ( p < 0.01) were independently associated with crossover to TFA. No major complications occurred. Minor puncture-site hematoma was developed in two patients (3.9%), severe radial-artery spasm in three (5.9%), and asymptomatic distal radial artery occlusion in three (5.9%). Conclusion The dTRA for neurointerventional procedures with a sheathless 8-Fr BGC demonstrates an acceptable success rate and safety profile. However, challenges remain with these procedures in older patients and cases with mechanical thrombectomy or local anesthesia with light sedation.