Puncture artery steno-occlusion after transradial and transulnar neurointervention: incidence, predictors, and follow-up outcomes.

PURPOSE: The transradial approach is increasingly used in neurointervention due to its minimally invasive nature and lower risk of severe access-related complications. However, radial artery steno-occlusion, although generally asymptomatic, may limit future vascular access. This study aimed to evaluate the incidence, predictors, and recanalization of puncture artery steno-occlusion following trans-wrist neurointervention.

METHODS

A retrospective institutional review was conducted on transradial and transulnar neurointerventions performed between February 2022 and May 2024. Postprocedural ultrasound was performed on the following day to assess puncture artery stenosis or occlusion. Risk factors were evaluated using univariate and multivariate logistic regression analyses. Follow-up ultrasound was conducted when available to assess recanalization.

RESULTS

Among 96 therapeutic trans-wrist procedures, puncture artery steno-occlusion was observed in 21 cases (22%). Complete occlusion occurred in 16 cases (17%), all asymptomatic. Multivariate analysis identified local anesthesia (OR 8.0, p < 0.05) and absence of preprocedural antiplatelet medication (OR 4.3, p < 0.05) as significant risk factors. The steno-occlusion rate was lower (6.6%) in cases performed under general anesthesia with preprocedural antiplatelet therapy. Follow-up ultrasound (median: 3.5 months) was available in 11 cases (52%), revealing persistent stenosis in all 4 stenosis cases and spontaneous recanalization in 4 of 7 occlusion cases (57%).

CONCLUSION

Puncture artery steno-occlusion occurred in 22% of therapeutic trans-wrist neurointerventions. Local anesthesia and absence of preprocedural antiplatelet medication were significant risk factors. Follow-up revealed both persistent steno-occlusion and recanalization, underscoring the importance of vascular reassessment before repeated access.