Comparison of Transradial and Transfemoral Neuroangiography in Pediatric Patients

Overview

This retrospective study compared transradial access (TRA) and transfemoral access (TFA) for neuroangiography in pediatric patients, focusing on technical success and complication rates. TRA demonstrated feasibility and safety comparable to TFA, with specific protocols to optimize outcomes and minimize complications.

Background

Transradial access has become popular in adult neurointerventional procedures due to its safety and patient preference but remains less common in pediatric neurovascular interventions. Concerns about smaller vessel size and risks such as vasospasm and thrombosis have limited TRA adoption in children. However, studies suggest radial artery size approaches adult dimensions by age 12, supporting the potential for TRA use in older children and adolescents. This study evaluates TRA's feasibility and safety compared to the conventional transfemoral approach in a tertiary pediatric setting.

Data Highlights

The study included pediatric patients aged 18 years or below undergoing neuroangiography or endovascular neurointerventions via either radial or femoral artery access. Exclusion criteria included multiple arterial access sites and use of vascular closure devices in TFA. TRA procedures utilized ultrasound guidance, hydrophilic sheaths, and a radial cocktail to reduce complications. Hemostasis protocols differed between TRA (inflatable compression device with early ambulation) and TFA (manual compression with 4–6 hours bed rest). Technical success was defined as completion of the procedure without access conversion.

Key Findings

• Transradial access was feasible and safe in pediatric neuroangiography, with technical success rates comparable to transfemoral access.
• Preprocedural ultrasound assessment of radial artery anatomy and diameter was critical to patient selection and procedural planning for TRA.
• Use of a radial cocktail (heparin, nitroglycerin, verapamil) and hydrophilic sheaths helped minimize vasospasm and thrombosis risks in TRA.
• TRA allowed immediate ambulation post-procedure, contrasting with the prolonged bed rest required after TFA.
• Radial artery occlusion predictors were evaluated to optimize patient safety and access site management.
• TRA was avoided in patients with high brachial artery bifurcation or unfavorable sheath-to-artery ratios to reduce vascular complications.

Clinical Implications

Transradial access can be considered a viable alternative to transfemoral access for pediatric neuroangiography in selected patients, especially those aged 12 years and older with suitable radial artery anatomy. Preprocedural ultrasound and careful patient selection are essential to minimize complications. The ability to allow early ambulation post-TRA may improve patient comfort and reduce hospital stay.

Conclusion

Transradial access is a feasible and safe approach for pediatric neurovascular procedures, offering comparable technical success to transfemoral access with potential benefits in patient recovery. Careful anatomical assessment and adherence to procedural protocols are key to optimizing outcomes.

References

1. Alehaideb et al 2020 -- Radial artery diameter in children approaches adult size by age 12
2. Society of Interventional Radiology Guidelines -- Coagulation and procedural protocols
3. Terumo Medical -- Glidesheath slender and vascular access devices