Comparison of procedural efficiency and safety between transradial and transfemoral approaches in elective diagnostic cerebral angiography: A retrospective cohort study

Diagnostic cerebral angiography is essential for the treatment of cerebrovascular disease. The conventional transfemoral approach (TFA) carries risks of vascular complications and longer recovery. The transradial approach (TRA) is a promising alternative; however, more evidence, especially direct comparisons with TFA, is needed to support its use in diagnostic procedures. This single-center retrospective cohort study compared TRA and TFA in elective diagnostic cerebral angiography. Overall, 96 patients treated between February 2021 and January 2024 were included, and 1:1 propensity-score matching was used to create 48 matched patients per group based on arterial access. The primary endpoint was the rate of overall procedural complications within 24 hours. The secondary endpoints included puncture, procedure, fluoroscopy, and hemostasis time. Statistical analysis was performed using Student t test, Mann-Whitney U-test, chi-square test, and Fisher test. Both groups showed 100% success with arterial puncture and selective angiography. Total procedure time was shorter with TRA (44.15 ± 8.75 vs 48.23 ± 10.56 minutes; P = .04), and hemostasis time was faster (5.53 ± 2.13 vs 7.08 ± 3.27 hours; P <.01). Complications were significantly lower in the TRA group (2.1% vs 14.6%; P = .02), with access-site hematomas and 1 pseudoaneurysm occurring mainly in the TFA group. For diagnostic cerebral angiography, TRA showed similar success to TFA but with greater efficiency, faster hemostasis, and significantly fewer access-site complications. TRA may be considered a preferred access strategy for eligible patients; however, given the retrospective observational design, the findings should be interpreted with caution and confirmed in prospective randomized studies.