To compare procedural outcomes, radiation exposure, and complication rates between TRA and TFA in diagnostic cerebral angiography.

Diagnostic cerebral angiography is essential for evaluating cerebrovascular diseases such as aneurysms, vascular malformations, and stroke. The transfemoral artery (TFA) approach remains the standard due to its familiarity and reliability, but the transradial artery (TRA) approach, first adopted in cardiology, has gained traction for its safety, lower access-site complications, and improved patient satisfaction. Comparative neuroendovascular data, particularly regarding radiation exposure and procedural efficiency, remain limited.

A retrospective review was conducted on 304 patients who underwent diagnostic cerebral angiography between 2018–2023 (TRA n=154; TFA n=150). Demographics, comorbidities, procedural metrics, and outcomes were extracted from electronic medical records. Continuous variables were analyzed using the Mann-Whitney U test, and categorical variables with Fisher’s exact test. Fluoroscopy and procedure times were normalized per vessel catheterized. Quantile regression identified predictors of normalized fluoroscopy time.

TFA patients were older (59.0 vs. 55.5 years, p=0.026) and were more likely to have had prior vascular access (59.3% vs. 33.1%, p<0.0001). TRA patients more commonly had hypertension (77.9% vs. 67.3%, p=0.04). When normalized, TFA demonstrated shorter fluoroscopy time (1.7 vs. 3.9 minutes, p<0.0001), procedure duration (3.5 vs. 7.1 minutes, p<0.0001), and fewer angiographic runs (2.3 vs. 3.8, p<0.0001). Complication rates were equally low (0.7% vs. 0.7%, p>0.99). On quantile regression, increasing age predicted longer normalized fluoroscopy time (β=0.020 minutes/year, p=0.0002); TFA was associated with a 2.1-minute per vessel increase in time (p<0.0001).

Both TRA and TFA are safe for diagnostic cerebral angiography with equivalent complication rates. TFA offers greater procedural efficiency, whereas TRA may improve patient comfort and reduce access-site morbidity. Access choice should be individualized, and future prospective studies are needed to refine selection criteria and optimize neuroangiography practice.