Abstract
INTRODUCTION Studies have demonstrated that transradial access (TRA) is safer than transfemoral access (TFA) during angiography. However, minimal data exists evaluating predictors of TRA failure. Furthermore, even less has been reported on peripheral artery involvement in Moyamoya disease. Therefore, we present the first analysis evaluating TRA failures in Moyamoya patients. METHODS All diagnostic cerebral angiograms at the University of Miami (UM) from 2018–2019 were retrospectively reviewed. The cohort was stratified based on initial site of access (TRA or TFA) and presence or absence of Moyamoya disease. Access failures/access site conversions were recorded for all patients. TRA and TFA groups were both analyzed using a Fisher's exact test to determine if a non-random association existed between Moyamoya disease and access site failures. P-values of ≤0.05 were considered statistically significant. RESULTS 803 diagnostic cerebral angiograms were identified at UM from 2018–2019. 476 patients had TRA as their initial site of access and 23 had Moyamoya disease. 349 had TFA of which 22 had Moyamoya. In the TRA group, Moyamoya patients were much more likely to experience access failure than the rest of the cohort (P = .0028). In contrast, the Moyamoya patients in the TFA group experienced no access site failures. The majority of TRA failures occurred because of inability to cannulate the vessel during puncture or because of vasospasm that prevented selection of the great vessels from the aortic arch. CONCLUSION Moyamoya patients are much more likely to experience TRA failure than other patients undergoing diagnostic cerebral angiography. Peripheral arterial involvement of Moyamoya disease is not a well-understood phenomenon and may be a contributing factor to the higher rates of TRA failure in this patient population.