Upper Brachial Artery Access Using a 4-French Sheath for Diagnostic Cerebral Angiography Prior to Transradial...

The transradial access (TRA) is often preferred for neurointerventional therapy; however, radial artery occlusion after diagnostic angiography may limit subsequent TRA. To preserve radial access for neurointerventional therapy, this study proposed using the right transbrachial access (TBA) with a 4-French (Fr) sheath as a method for diagnostic angiography.

A retrospective analysis was performed on 51 patients who underwent diagnostic cerebral angiography via the right TBA and subsequently received neurointerventional therapy using right-sided TRA between April 2023 and March 2025. In all cases, a 4-Fr short sheath was inserted into the right upper brachial artery for angiography of the ipsilateral forearm and brachial arteries. If anatomical anomalies were noted, additional left-arm angiography was conducted to assess the feasibility of left-sided TRA during future therapy.

The mean age of the participants was 67.9 years, and 19 were women. Minor and transient events included puncture-site pain (3.9%) and transient forearm numbness (3.9%), and analgesics were used in 5.9% of cases. There was no subcutaneous hematoma or hemorrhagic event requiring intervention. On angiography during neurointerventional treatment, one (2.0%) patient presented with mild stenosis at the brachial puncture site, and no procedure-related issues were observed. No pseudoaneurysm, arteriovenous fistula, or hematoma with swelling was detected.

The use of the TBA strategy with a 4-Fr sheath in preoperative diagnostic angiography preserves radial artery patency while allowing anatomical evaluation. Hence, this method is a relatively safe and feasible option for centers adopting TRA-based neurointervention.