Transradial versus transfemoral access for pediatric intra-arterial chemotherapy for retinoblastoma

Transradial access (TRA) has gained popularity among neurointerventionalists due to its shorter procedure time and fewer complications compared to transfemoral access (TFA). The literature on the feasibility of TRA in pediatric patients undergoing intra-arterial chemotherapy (IAC) for retinoblastoma (Rb) is limited. This study compares procedural efficiency and postoperative recovery time among IAC patients undergoing TRA versus TFA.

The authors conducted a retrospective single-center study of pediatric patients undergoing IAC through TRA or TFA for Rb from January 2019 to January 2025. Outcomes of interest were procedure time, recovery time in the postanesthesia care unit, and dose of dexmedetomidine (mcg/kg) received during recovery. Inverse probability of treatment weights (IPTWs) was used to adjust for confounding variables between the two treatment groups (TRA vs TFA).

Of 255 IAC procedures included, 14.9% (n = 38) of cases were performed through TRA and 85.1% (n = 217) through TFA. In the unadjusted analysis, TRA was associated with a mean 27.3-minute decrease in procedure time (95% CI -35.22 to -19.38 minutes, p < 0.001), 136.91-minute decrease in recovery time (95% CI -195.49 to -78.32 minutes, p < 0.001), and a 102.55-mcg/kg reduction in dexmedetomidine dose during the postoperative period (95% CI -120.33 to -84.78 mcg/kg, p < 0.001). After IPTWs adjustment, TRA was associated with a mean 33.17-minute decrease in procedure time compared to TFA (95% CI -39.38 to -26.97 minutes, p < 0.001) and a mean 2459.9-mGy⋅cm2 (95% CI -4139.24 to -780.52 mGy⋅cm2, p < 0.01) decrease in radiation exposure. TRA patients experienced a mean 158.58-minute decrease in recovery time (95% CI -214.95 to -102.23 minutes, p < 0.001) and also received lower doses of dexmedetomidine (mcg/kg) compared to TFA (mean -106.95, 95% CI -117.16 to -96.73 mcg/kg; p < 0.001). One patient in each group (TRA and TFA) developed bronchospasm. One patient developed ophthalmic artery occlusion during their third IAC procedure.

In pediatric patients undergoing IAC for Rb, TRA is associated with reduced radiation exposure, shorter procedure and recovery time, and lower sedation requirements compared to TFA.