Incidence and Predictors of Post-procedural Radiographic Infarct Lesions After Transfemoral versus Transradial Diagnostic Cerebral Angiography

Introduction: Radial artery access has become more prevalent in use by neurointerventionalists; however, owing to its novelty, outcome measures must be further elucidated compared to neuro-angiography performed via transfemoral access. In this study, we investigate the incidence of post-procedural DWI lesions seen MRI after transradial vs transfemoral angiography and evaluate possible contributing factors.

Methods: A retrospective analysis was conducted of patients who presented with angiogram-negative subarachnoid hemorrhage at our institution between June 2018-September 2022 and had post-angiography MRI brain performed during the same hospitalization. Clinical, radiographic, and operator variables were analyzed to evaluate contributing factors of post-angiography DWI lesions identified between the transradial vs transfemoral cohort.

Results: A total of 84 patients met inclusion criteria for the study (N=43 transfemoral vs. N=41 transradial). There was no difference in patient demographic factors between the two cohorts. The mean angiogram duration was similar between the transfemoral group (39.8+/-18.3 mins) and transradial group (40.6+/-16.5 mins), p=0.835. The median number of vessels selectively catheterized was 5 (IQR 4-6) for both cohorts, as was the duration between angiogram and subsequent MRI. Transfemoral access had almost twice the incidence of DWI lesions seen on post-angiography MRI compared to transradial (40% vs. 22%, p=0.081). Univariate analysis identified older age (p=0.014) and angiograms performed in the first half of the academic year (July-Dec) (p=0.02) as being predictors of post-angiography DWI lesions. Logistic regression analysis revealed older age (OR 1.041 (95% CI: 1.00-1.08), p=0.05), transfemoral access (OR 3.38 (95% CI: 1.11-10.24), p=0.032) and angiograms performed between July-Dec (OR 3.38 (95% CI: 1.14-10.03), p=0.028) as factors that portended increased likelihood of post-angiography DWI lesions.

Conclusion : This study suggests that a combination of patient and operator factors contribute towards the incidence of post-angiography DWI lesions after transfemoral vs transradial angiography, and have broad implications for neurointerventionalists to deliberate with further investigations.