The Transradial Approach for Endovascular Treatment of Vasospasm

Patients treated with permissive hypertension during cerebral vasospasm, particularly those on antiplatelets, may have an increased risk of femoral access site complications after endovascular therapy. This study aimed to identify potential risks associated with endovascular access approach and the impact of dual antiplatelet therapy (DAPT) on complications in intra-arterial therapy for vasospasm.

A prospectively maintained database was queried for patients undergoing endovascular treatment of aneurysmal subarachnoid hemorrhage-related cerebral vasospasm to compare access-site complications between femoral and radial access. Subgroup and multivariate analyses were performed to parse out effect sizes of access and the use of periprocedural DAPT.

A total of 422 endovascular procedures were included: 30% transradial (TRA), 69% transfemoral (TFA), and 1% crossover from radial to femoral access. The access-site complication rate was 4% overall, including a 3.8% access-related hemorrhagic complication rate and a 0.2% rate of femoral artery occlusion. TRA had a lower complication rate of 0.8% as compared with 5.4% in the TFA group (95% CI of difference-in-proportions 0.7%-7.5%, P = .03), remaining significant in a multivariate analysis (adjusted odds ratio 0.05 [95% CI 0.004-0.78]; P = .03). Among the subgroup of patients taking DAPT, the hemorrhagic complication rate of TFA was 13.5% as compared with 3.8% in TRA. A multivariate analysis demonstrated a 7-fold higher access site hemorrhagic complication risk when using TFA in patients on DAPT (adjusted odds ratio 7.2 [1.9-27.0]; P = .003).

Radial access was associated with a significantly lower rate of access-site complications when treating postaneurysmal subarachnoid hemorrhage cerebral vasospasm, particularly in patients on DAPT.