Transradial ‘combined catheter’ technique for six-vessel cerebral angiography

Background: Compared with transfemoral access (TFA), transradial access (TRA) has been widely used in neurointervention, as it has a relatively low rate of access-site complications. However, the method still has several restrictions, particularly with regard to selective angiography. This study aimed to evaluate the technical feasibility and procedural performance of a combined catheter technique designed to facilitate complete six-vessel selective cerebral angiography via TRA. Methods: We prospectively studied patients who underwent TRA selective cerebral angiography with the combined catheter technique between January 2023 and September 2023. Clinical characteristics, procedural details, complications, and outcomes at discharge were collected. A descriptive analysis was performed. Results: A total of 48 patients underwent TRA angiography using the combined catheter technique, 15 of whom were male. The median age of the patients was 54.81 ± 13.62 years (30-82). The intermediate or distal catheter types used in patients were Tethys in 27 cases, Envoy DAXB in 6 cases, Envoy DA in 6 cases, and Navien in 9 cases. All patients successfully received selective six-vessel angiography, including bilateral internal carotid arteries (ICAs), external carotid arteries (ECAs), and vertebral arteries (VAs), and completed the follow-up neurointervention procedure. Image quality scores for the arterial phase, capillary apparatus, and venous phase were all approximately 15, which indicates that all patients showed superior visualization of the vasculature. Average selection times per vessel were 230.50 ± 72.80 s (124-395). Conclusion: In this small single-center feasibility series, the combined catheter technique for six-vessel TRA cerebral angiography appeared technically feasible and safe, but these preliminary findings require confirmation in larger comparative studies.