Safety profile of trans-radial approach (TRA) in patients with radial artery loop in neurointervention: retrospective analysis of a TRA-dedicated neurovascular center experience over 4 years

Wei Cao; Rongguo Hu; Si Zhao Tang; Dandan Jia; Deyuan Zhu; Dayong Qi; Kangqing Zhang; Tonghui Song; Yibin Fang

doi:10.1016/j.jocn.2025.111400

Safety profile of trans-radial approach (TRA) in patients with radial artery loop in neurointervention: retrospective analysis of a TRA-dedicated neurovascular center experience over 4 years

J Clin Neurosci. 2025 Jun 27:139:111400. doi: 10.1016/j.jocn.2025.111400. Online ahead of print.

Authors

Wei Cao¹, Rongguo Hu², Si Zhao Tang³, Dandan Jia², Deyuan Zhu², Dayong Qi², Kangqing Zhang⁴, Tonghui Song⁵, Yibin Fang⁶

Affiliations

¹ Department of Neurovascular Disease, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai 200434, China. Electronic address: 1023122590@qq.com.
² Department of Neurovascular Disease, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai 200434, China.
³ Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital (NUH), National University Health System (NUHS), Singapore. Electronic address: sizhao.tang@gmail.com.
⁴ Department of Neurovascular Disease, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai 200434, China. Electronic address: 631135639@qq.com.
⁵ Department of Neurovascular Disease, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai 200434, China. Electronic address: 1370168159@qq.com.
⁶ Department of Neurovascular Disease, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai 200434, China. Electronic address: fangyibin4@163.com.

PMID: 40580758
DOI: 10.1016/j.jocn.2025.111400

Abstract

Introduction: The presence of radial artery loops - complete 360° loop along the radial artery, can complicate transradial approach (TRA) in neurointerventional surgeries. Our study aims to evaluate the safety profile of TRA in patients with radial artery loops and proposes strategies for managing radial artery loops to improve the success rate of TRA.

Methods: This is a single-center retrospective study, which included all patients with radial artery loops who underwent neurointerventional procedures via TRA over 4 years (2021-2024). Data on baseline patient characteristics, relevant TRA anatomical data, periprocedural complications (e.g. vessel wall injury e.g. perforation), conversion to femoral access, radial artery patency at 3 months follow-up were collected.

Results: Radial artery loops were present in 29 patients from TRA database (total of 945 patients). The average age of patients was 75.5 years old (13 males, 16 females). TRA was successful in 27 out of 29 patients (93.1 %). Radial artery perforation occurred in 2 patients (6.9 %), both managed conservatively with manual compression. At the 3-month follow-up, radial artery patency was preserved in all cases.

Conclusions: TRA in patients with radial artery loops is feasible with a favorable safety profile when appropriate techniques are employed. However, the observed 7% rate of radial artery perforation highlights the need for careful case selection and emphasizes that loop navigation should be reserved for centers with sufficient expertise and clinical justification. Reinforcing the role of preliminary ultrasound screening, particularly when extended proximally, may help identify anatomical variants such as radial loops in advance, thereby reducing procedural complexity and improving planning.

Keywords: Cerebral angiography; Endovascular neurosurgery; Neurointervention; Radial artery loop; Transradial access.