Transradial cerebral angiography in the neonate and infant: a case series

We aim to share our experience of transradial access (TRA) for cerebral angiography and intervention in five patients ranging from 6 days to 7 months of age.

In this institutional review board-approved, retrospective case series, we reviewed all patients who underwent TRA for cerebral angiography with and without intervention. We describe three techniques for radial artery cannulation, namely: (1) bareback; (2) with a micropuncture sheath; and (3) with an intravenous catheter. Demographic, clinical, procedural, and imaging data were abstracted from the patients' medical records.

From September 2019 to August 2023, five patients (median age and weight, 24 days (range 6-218 days) and 4.2 kg (range 3.2-6.2 kg)) underwent TRA for cerebral angiography. Four patients underwent diagnostic cerebral angiography, two via left TRA and two via right TRA. One patient was definitively treated with endovascular embolization for an arteriovenous fistula. Median procedural length was 1.5 hours (range 1-2.2 hours) and median effective skin dose was 88.7 mGy (range 48.8-140.3 mGy). No procedures required conversion to femoral artery access to obtain diagnostic quality imaging or to facilitate intervention. No complications related to the accessed radial artery were recorded.

We have demonstrated that TRA in the neonate and infant is feasible. In our experience this technique is safe and effective for diagnostic cerebral angiography. Additionally, select intervention via TRA in this population may be possible as demonstrated by our single example of endovascular management of an intracranial fistula.