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Prospective Multicenter Observational Study of Silent Brain Infarction following Transradial Hepatic Intervention
Yuji Koretsune1, Miyuki Sone2, Shintaro Kimura2
1Department of Diagnostic and Interventional Radiology, Osaka University, Osaka, Japan.
Journal of Vascular and Interventional Radiology : JVIR
|August 8, 2025
Summary
Transradial hepatic interventions can cause silent brain infarction. Modifying protocols to select patients with favorable anatomy and ensure continuous catheter flushing significantly reduced this risk.
Area of Science:
- Interventional Radiology
- Neurology
- Cardiovascular Research
Background:
- Transradial access (TRA) is increasingly used for hepatic interventions.
- Silent brain infarction (SBI) is a potential complication of endovascular procedures.
- Understanding the incidence and risk factors for SBI in hepatic interventions is crucial.
Purpose of the Study:
- To determine the incidence of silent brain infarction (SBI) after transradial hepatic interventional procedures.
- To identify risk factors associated with SBI in this patient population.
Main Methods:
- A multicenter prospective observational study involving 57 patients undergoing transradial hepatic intervention.
- Pre- and post-procedural magnetic resonance imaging (MRI) to detect SBI.
- Comparison of two study periods with modified selection criteria (left subclavian artery angle >50°) and protocol (heparinization, catheter flushing) in the latter period.
Main Results:
- Silent brain infarction (SBI) was detected in 16.4% of patients (9/55), with no symptomatic events.
- The incidence of SBI significantly decreased from 40% in the initial period to 2.9% in the latter period (P<0.001).
- Prolonged catheterization time (left subclavian artery to descending thoracic aorta >58 seconds) and a left SCA angle ≤50° were identified as risk factors for SBI.
Conclusions:
- Transradial hepatic intervention is associated with a significant incidence of silent brain infarction (SBI).
- Implementing stricter patient selection (favorable anatomy) and procedural protocols (heparinization, catheter perfusion) can substantially reduce SBI incidence.
- These findings support optimizing transradial techniques to improve patient safety in hepatic interventions.
