Comparison of Transradial and Transfemoral Access for Cerebral Digital Subtraction Angiography Across Different Aortic Arch Types: A Prospective Randomized Controlled Trial

OBJECTIVE: To investigate the operational efficiency, safety, and postoperative recovery differences between the transradial approach (TRA) and the transfemoral approach (TFA) in performing digital subtraction angiography (DSA) in patients with different aortic arch types. Additionally, to compare the applicability of Simmon 1 and Simmon 2 catheters in complex aortic arch configurations. METHODS: This single-center, prospective, randomized controlled trial included 114 patients with cerebrovascular disease scheduled for DSA. Preoperative aortic arch computed tomography angiography (CTA) was performed on all patients to classify the aortic arch into type I, type II, or type III, with 38 patients in each group. Each arch type was then randomly assigned in a 1:1 ratio to either the TRA (n=57) or TFA (n=57) group. The comparison between the 2 groups included puncture time, fluoroscopy time, contrast agent usage, postoperative hemostasis time, immobilization time, and the incidence of puncture-related complications for each aortic arch type. For patients with type III aortic arch in the TRA group, a further random allocation was made to use either the Simmon 1 or Simmon 2 catheter to assess differences in performance for complex arch types. RESULTS: Baseline characteristics between the 2 groups were similar. Compared with the TFA group, the TRA group had a longer puncture time (29.08±1.53 min vs 20.11±1.65 min, p