Kim Hoon, Lee Hyeong Jin, Choi Seon Woong, Kim Sunghan, Kim Seong-Rim, Park Ik Seong
From the Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
From the Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
AJNR Am J Neuroradiol. 2025 Jun 3;46(6):1166-1172. doi: 10.3174/ajnr.A8625.
Transradial access (TRA) for cerebral angiography has become more popular due to fewer complications and greater patient comfort compared with transfemoral access. However, the frequency and nature of neurologic complications linked to TRA remain unclear. This study aimed to determine the incidence of symptomatic neurologic complications after transradial cerebral angiography, identify risk factors, and characterize clinical and imaging features of these complications.
We retrospectively analyzed 1679 consecutive cases of transradial cerebral angiography from a single institution between January 2018 and December 2020. Neurologic complications were defined as any symptomatic changes confirmed by DWI revealing ischemic lesions. A case-control matching method was used to enhance the reliability of the results. Clinical, procedural, and anatomic factors were examined for predictors of neurologic complications.
Neurologic complications occurred in 1.0% ( = 19) of cases, with 85% occurring within 6 hours postprocedure. No significant predictors of neurologic complications could be identified among the clinical, procedural, or anatomic factors assessed. Overall, 58% of patients experienced transient or reversible complications. Patients with permanent symptoms had mild to moderate disability (mRS scores of 1 or 2), with no severe disability (mRS score ≥3). DWI commonly showed multifocal cortical or subcortical ischemic patterns, typically affecting the right middle cerebral artery territory or multiple territories, suggesting embolic mechanisms as a potential cause.
Neurologic complications following transradial cerebral angiography were rare but occurred early in the postprocedural period. The observed ischemic patterns, particularly the right-sided predominance, suggest embolic mechanisms as a potential cause. However, further large-scale, multicenter prospective studies are essential to identify risk factors more clearly and enhance patient safety in this increasingly utilized transradial approach.
与经股动脉入路相比，经桡动脉入路（TRA）用于脑血管造影因并发症更少且患者舒适度更高而变得更受欢迎。然而，与TRA相关的神经系统并发症的发生率和性质仍不清楚。本研究旨在确定经桡动脉脑血管造影术后有症状的神经系统并发症的发生率，识别危险因素，并描述这些并发症的临床和影像学特征。
我们回顾性分析了2018年1月至2020年12月期间来自单一机构的1679例连续经桡动脉脑血管造影病例。神经系统并发症定义为经DWI证实有缺血性病变的任何有症状改变。采用病例对照匹配方法以提高结果的可靠性。检查临床、操作和解剖因素以寻找神经系统并发症的预测因素。
1.0%（n = 19）的病例发生了神经系统并发症，其中85%在术后6小时内发生。在评估的临床、操作或解剖因素中未发现神经系统并发症的显著预测因素。总体而言，58%的患者经历了短暂或可逆的并发症。有永久性症状的患者有轻度至中度残疾（mRS评分为1或2），无严重残疾（mRS评分≥3）。DWI通常显示多灶性皮质或皮质下缺血模式，通常影响右侧大脑中动脉区域或多个区域，提示栓塞机制可能是潜在原因。
经桡动脉脑血管造影术后的神经系统并发症很少见，但发生在术后早期。观察到的缺血模式，特别是右侧优势，提示栓塞机制可能是潜在原因。然而，进一步的大规模、多中心前瞻性研究对于更清楚地识别危险因素和提高这种日益常用的经桡动脉入路的患者安全性至关重要。
