Feasibility and Safety of 8F Guiding Catheter Navigation in Transradial Neurointervention for Unruptured Intracranial Aneurysms: A Propensity Score-Matched Comparison of Sheath-Based versus Sheathless Approaches

The feasibility and safety of using 8F sheaths for endovascular treatment via the transradial approach (TRA) remain underexplored. This study evaluated whether the use of an 8F guiding catheter with or without an 8F sheath affects procedural success rates and access-site complications.

We retrospectively reviewed 211 unruptured intracranial aneurysms in 207 patients treated via TRA with an 8F guiding catheter at 3 institutions between March 2021 and January 2025. Patients were divided into 2 groups: those treated with a sheath (Group S) and those without a sheath (Group NS). Propensity score matching was used to control for baseline differences when assessing the association between 8F sheath use and complication rates.

A total of 44 aneurysms (21%) were treated via TRA by using an 8F guiding catheter with a sheath, achieving successful treatment in all cases. Propensity score matching resulted in 30 paired aneurysms from Group S and Group NS. The incidence of radial artery occlusion and radial artery spasm was significantly lower in Group S (0% and 20%, respectively) compared with Group NS (30% and 53%, respectively; P = .002 and .015). No significant differences were observed between the groups in access-site or non-access-site complications, nor in procedural success rates.

The use of an 8F guiding catheter with an 8F sheath for the treatment of unruptured intracranial aneurysms via the TRA appears feasible and may reduce the risk of radial artery occlusion and radial artery spasm without increasing the incidence of access-site or non-access-site complications.