Comparison of the Safety, Efficacy, and Procedural Characteristics Associated with Proximal and Distal Radial Access for Diagnostic Cerebral Angiography


      • pTRA and dTRA were associated with similar procedure durations and access times.
      • There was a 3% minor complication rate, which was similar between access sites.
      • No patients experienced a major complication.
      • There was a 1.05% crossover rate to TFA, which was similar between access sites.



      Radial access is an increasingly popular approach for performing cerebral angiography. There are two sites for radial artery puncture: proximal transradial access (pTRA) in the wrist and distal transradial access (dTRA) in the snuffbox. These approaches have not been directly compared.

      Materials and methods

      Consecutive diagnostic cerebral angiograms performed at a single institution were retrospectively reviewed. Outcomes included fluoroscopy time, radiation dose, contrast volume, time to obtain access, procedure duration, and time to discharge home. Success rates as well as minor and major complication rates associated with each approach were also compared. Multivariate linear regression models were used to determine the relationship between access site and outcomes while adjusting for covariates.


      A total of 287 angiograms on 244 patients met the inclusion criteria. pTRA was associated with shorter fluoroscopy time (ß -2.54, 95% CI -4.18 - -0.9, p = 0.003) and lower radiation dose (ß -242.89, 95% CI -351.55 - -134.24, p < 0.001), but not contrast volume. Time to obtain access, procedure duration, and time to discharge home were similar between approaches. A total of 10 minor complications occurred with similar rates for each approach (8 for dTRA, 2 for pTRA, p = 0.168) and there were no major complications. The conversion rate to femoral access was low (1.05% overall) and did not differ with approach.


      dTRA and pTRA are associated with similarly high rates of safety and efficacy. Procedure duration, time to obtain access, and time to discharge did not differ between approaches.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Valgimigli M.
        • Gagnor A.
        • Calabró P.
        • et al.
        Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.
        Lancet. 2015; 385: 2465-2476
        • Khanna O.
        • Mouchtouris N.
        • Sweid A.
        • et al.
        Transradial approach for acute stroke intervention: technical procedure and clinical outcomes.
        Stroke Vasc Neurol. 2019; 5: 103-106
        • Chivot C.
        • Bouzerar R.
        • Yzet T.
        Transitioning to transradial access for cerebral aneurysm embolization.
        AJNR Am J Neuroradiol. 2019; 40: 1947-1953
        • Snelling B.M.
        • Sur S.
        • Shah S.S.
        • et al.
        Transradial cerebral angiography: techniques and outcomes.
        J Neurointerventional Surg. 2018; 10: 874-881
        • Brunet M.C.
        • Chen S.H.
        • Sur S.
        • et al.
        Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography.
        J Neurointerventional Surg. 2019; 11: 710-713
        • Brueck M.
        • Bandorski D.
        • Kramer W.
        • et al.
        A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty.
        JACC Cardiovasc Interv. 2009; 2: 1047-1054
        • Jolly S.S.
        • Yusuf S.
        • Cairns J.
        • et al.
        Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (rival): a randomised, parallel group, multicentre trial.
        Lancet. 2011; 377: 1409-1420
        • Hamon M.
        • Rasmussen L.H.
        • Manoukian S.V.
        • et al.
        Choice of arterial access site and outcomes in patients with acute coronary syndromes managed with an early invasive strategy: the acuity trial.
        EuroIntervention. 2009; 5: 115-120
        • Cesaro A.
        • Moscarella E.
        • Gragnano F.
        • et al.
        Transradial access versus transfemoral access: a comparison of outcomes and efficacy in reducing hemorrhagic events.
        Expert Rev Cardiovasc Ther. 2019; 17: 435-447
        • Joshi K.C.
        • Beer-Furlan A.
        • Crowley R.W.
        • et al.
        Transradial approach for neurointerventions: a systematic review of the literature.
        J Neurointerventional Surg. 2020; 12: 886-892
        • Gao B.L.
        • Xu G.Q.
        • Wang Z.L.
        • et al.
        Transradial stenting for carotid stenosis in patients with bovine type and type iii aortic arch: experience in 28 patients.
        World Neurosurg. 2018; 111: e661-e667
        • Lu H.
        • Wu D.
        • Chen X.
        Comparison of distal transradial access in anatomic snuffbox versus transradial access for coronary angiography.
        Heart Surg Forum. 2020; 12: E407-E410
        • Mori S.
        • Hirano K.
        • Yamawaki M.
        • et al.
        A comparative analysis between ultrasound-guided and conventional distal transradial access for coronary angiography and intervention.
        J Interv Cardiol. 2020; 20207342732
        • Hammami R.
        • Zouari F.
        • Abdessalem M.
        • et al.
        Distal radial approach versus conventional radial approach: a comparative study of feasibility and safety.
        Libyan J Med. 2021; 161830600
        • Vefali V.
        • Saricam E.
        The comparison of traditional radial access and novel distal radial access for cardiac catheterization.
        Cardiovasc Revascularization Med. 2020; 21: 496-500
        • Bhambhani A.
        • Pandey S.
        • Nadamani A.N.
        • et al.
        An observational comparison of distal radial and traditional radial approaches for coronary angiography.
        J Saudi Heart Assoc. 2020; 17: 17-24
        • Stone J.G.
        • Zussman B.J.
        • Tonetti D.A.
        • et al.
        Transradial versus transfemoral approaches for diagnostic cerebral angiography: a prospective, single-center, non-inferiority comparative effectiveness study.
        J Neurointerventional Surg. 2020; 12: 993-998
        • Aoi S.
        • Htun W.W.
        • Freeo S.
        • et al.
        Distal transradial artery access in the anatomical snuffbox for coronary angiography as an alternative access site for faster hemostasis.
        Catheter Cardiovasc Interv. 2019; 94: 651-657
        • Koutouzis M.
        • Kontopodis E.
        • Tassopoulos A.
        • et al.
        Distal versus traditional radial approach for coronary angiography.
        Cardiovasc Revascularization Med. 2019; 20: 678-680
        • Hamandi M.
        • Saad M.
        • Hasan R.
        • et al.
        Distal versus conventional transradial artery access for coronary angiography and intervention: a meta-analysis.
        Cardiovasc Revascularization Med. 2020; 21: 1209-1213
        • Patel P.
        • Majmundar N.
        • Bach I.
        • et al.
        Distal transradial access in the anatomic snuffbox for diagnostic cerebral angiography.
        AJNR Am J Neuroradiol. 2019; 40: 1526-1528
        • Pons R.B.
        • Caamano I.R.
        • Chirife O.S.
        • et al.
        Transradial access for diagnostic angiography and interventional neuroradiology procedures: a four-year single-center experience.
        Interv Neuroradiol. 2020; 26: 506-513
        • Saito S.
        • Hasegawa H.
        • Ota T.
        • et al.
        Safety and feasibility of the distal transradial approach: a novel technique for diagnostic cerebral angiography.
        Interv Neuroradiol. 2020;
      1. Sattur MG, Almallouhi E, Lena JR, et al. Llustrated guide to the transradial approach for neuroendovascular surgery: a step-by-step description gleaned from over 500 cases at an early adopter single center. Oper Neurosurg;19:181-189.

        • van der Heijden D.J.
        • van Leeuwen M.A.H.
        • Ritt M.
        • et al.
        Chronic radial artery occlusion does not cause exercise induced hand ischemia.
        J Interv Cardiol. 2018; 31: 949-956
        • Romano D.G.
        • Frauenfelder G.
        • Tartaglione S.
        • et al.
        Trans-radial approach: technical and clinical outcomes in neurovascular procedures.
        CVIR Endovasc. 2020; 3: 58
        • Chen S.H.
        • Brunet M.C.
        • Sur S.
        • et al.
        Feasibility of repeat transradial access for neuroendovascular procedures.
        J Neurointerventional Surg. 2020; 12: 431-434