Evaluation of Factors Influencing Embolic Brain Ischemic Lesions Using Diffusion-Weighted Imaging during the Learning Phase of Transradial Diagnostic Cerebral Angiography

Abstract Vascular access is a pivotal step regarding the success of any interventional procedure. Traditionally, the transfemoral route has been the most commonly practised among the neurointerventionists. The transradial approach (TRA) has firmly established itself in interventional cardiology, and its practice among neurointerventionists has been slowly but steadily gaining popularity. The objective is to evaluate the factors that may influence the incidence of embolic brain diffusion-weighted imaging (DWI) hits during the learning phase of transradial diagnostic cerebral angiography. This was a single-center observational descriptive study conducted in the Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh. A total of 65 patients with indications underwent diagnostic cerebral angiography via the transradial route. Magnetic resonance imaging (MRI) was performed within 24 hours after the procedure. Grading of DWI hits was done from 0 to 4. The off angles of the great vessels of the neck were evaluated from prior computed tomography angiography or postprocedure magnetic resonance angiography. Postprocedure MRI was available in 45 patients, whereas the remaining 20 patients, for whom MRI was not available, were excluded. DWI hits were seen in 16 of 45 patients (35.5%), and the remaining 29 of 45 patients (64.5%) were DWI-negative. Of these 16 patients, the majority had a Grade 1 DWI (20%) or Grade 2 (7%) DWI hit, with Grade 3 and Grade 4 DWI hits observed in 4% of patients each. Only four patients were symptomatic, and all experienced an early recovery. Ischemic lesions in the anterior circulation were more common than those in the posterior circulation. A greater angle of origin and relatively fast catheterization of the left vertebral artery was associated with higher DWI lesions using the right radial access. TRA is a promising technique for interventional radiology. TRA during the learning phase can be associated with DWI lesions; the majority of which will be clinically silent. Left vertebral artery catheterization from the right radial artery should be avoided or practised cautiously during the learning phase of TRA.