Comparison of Transradial and Transfemoral Access for Cerebral Digital Subtraction Angiography Across Different Aortic Arch Types: A Prospective Randomized Controlled Trial

TRA demonstrated excellent safety and postoperative recovery advantages across different aortic arch types, with a particular adaptive benefit in type III aortic arch patients. The Simmon 2 catheter performed better in TRA-treated type III arch patients, supporting individualized approach and catheter selection based on preoperative aortic arch morphology. This strategy may improve procedural efficiency, reduce complications, and optimize patient outcomes. Further validation in larger, multicenter studies is recommended.Clinical ImpactThis study validates the TRA as a safer, more efficient alternative to transfemoral access for cerebral angiography, regardless of aortic arch complexity. It challenges the hesitation to use TRA in Type III arches by demonstrating significantly reduced complications and faster recovery. A key innovation is the stratified evaluation of catheters, identifying the Simmon 2 catheter as superior for Type III arches to optimize contrast usage and hemostasis. For clinicians, this supports shifting toward individualized, anatomy-based strategies, encouraging the use of TRA with specific catheter selection to improve safety and patient outcomes in neurointerventional procedures.