Caution for Forearm Radial Artery Tortuosity: a Risk of Transradial Neuroendovascular Procedure Failure

The transradial artery approach (TRA) has recently gained popularity in neuroendovascular procedures with its advantages of the fewer complications and reduced invasiveness. However, forearm radial artery (RA) tortuosity has led to procedural failure in some cases. Therefore, this study aimed to investigate the influence of forearm RA tortuosity on TRA failure and evaluate its association with patients' characteristics and the procedure-related factors.

We retrospectively examined the characteristics of 239 patients who underwent neuroendovascular procedures at our facility between January 2023 and November 2024.

Among the 239 patients, 28 exhibited forearm RA tortuosity, and switching from TRA was significantly more frequent among these patients (64.3% vs. 5.2%, p < 0.01). Additionally, they were significantly older (74.8 vs. 60.6 [years], p < 0.01), shorter in stature (1.55 vs. 1.62 [m], p < 0.01), and lighter in body weight (53.0 vs. 60.0 [kg], p < 0.01). Moreover, they were complicated with dyslipidemia (57.1% vs. 36.5%, p = 0.04). The cut-off values associated with an increased risk of forearm RA tortuosity were age > 71 years (p < 0.0001), height < 1.60 m for men (p = 0.0365), and height < 1.55 m for women (p = 0.0010).

Forearm RA tortuosity significantly influenced the choice of neuroendovasucular approach and was significantly correlated with the age and physique of patients. Pre-procedural evaluation of the forearm RA course is crucial in TRA, and preparation for switching the approach from TRA was hoped in high-risk cases.