Transradial versus transfemoral neuroangiography in a tertiary pediatric hospital-a propensity score matched study.

Abstract

To evaluate the feasibility and safety of transradial access (TRA) in comparison to transfemoral access (TFA) in pediatric neurovascular procedures. In this single-center retrospective cohort study, 729 pediatric neurovascular procedures performed between January 2020 and December 2024 were reviewed, including 175 TRAs and 540 TFAs. Primary outcomes included technical success and adverse events, while secondary outcomes assessed radiation dose, fluoroscopy time, and procedural duration. Propensity score matching (1:1) was applied to adjust for imbalance in baseline covariates. Statistical significance was defined at p < 0.05. One hundred matched pairs of TRA and TFA were analyzed (TRA median age 13.9 [IQR 11.7-15.3] years, 52 females; TFA median age 14.5 [IQR 11.6-16.4] years, 51 females). Technical success rates were similar between TRA (98%) and TFA (99%, p > 0.99). TRA was associated with a higher rate of vasospasm (7% vs 1%, p = 0.03) but a lower rate of hematoma formation (2% vs 9%, p = 0.03). Despite the longer fluoroscopy time in the TRA group (19.4 min vs 8.8 min, p < 0.001), the radiation dose and procedural time were comparable between both groups. Asymptomatic radial artery occlusion (RAO) was detected in 5.1% (9/175) of radial accesses. A sheath-to-artery ratio ≥ 1 was independently associated with RAO (odds ratio, 6.13; 95% CI: 1.32, 28.4; p = 0.02). TRA is technically feasible for pediatric neurovascular procedures in a selected population. Further prospective studies should be performed to evaluate the mid to long-term outcome of patients with asymptomatic RAO. Question Despite widespread adoption in adult neurointerventional practice, evidence of transradial access (TRA) in the pediatric population remains limited. Findings TRA has a comparable technical success rate to transfemoral access (TFA) in a large cohort of neurovascular procedures in a selected pediatric population. Clinical relevance TRA is a technically feasible alternative to TFA for pediatric neurovascular procedures in a selected group of patients. Preprocedural ultrasound assessment of the radial artery and optimization of the sheath-to-artery ratio are essential for minimizing radial artery occlusion.