# Upper Brachial Artery Access Using a 4-French Sheath for Diagnostic Cerebral Angiography Prior to Transradial Neurointerventional Therapy: A Single-Center Retrospective Study

## TL;DR

This study shows that using the brachial artery for diagnostic angiography with a small sheath helps preserve the radial artery for later procedures.

## Contribution

The study introduces a novel approach using transbrachial access with a 4-French sheath to preserve radial artery access for neurointerventional therapy.

## Key findings

- Using a 4-French sheath in the brachial artery caused minimal complications and preserved radial artery patency.
- Only minor issues like puncture-site pain and transient numbness were observed in a small percentage of patients.
- No major complications such as hematoma or pseudoaneurysm occurred during or after the procedure.

## Abstract

Purpose: The transradial access (TRA) is often preferred for neurointerventional therapy; however, radial artery occlusion after diagnostic angiography may limit subsequent TRA. To preserve radial access for neurointerventional therapy, this study proposed using the right transbrachial access (TBA) with a 4-French (Fr) sheath as a method for diagnostic angiography.

Materials and methods: A retrospective analysis was performed on 51 patients who underwent diagnostic cerebral angiography via the right TBA and subsequently received neurointerventional therapy using right-sided TRA between April 2023 and March 2025. In all cases, a 4-Fr short sheath was inserted into the right upper brachial artery for angiography of the ipsilateral forearm and brachial arteries. If anatomical anomalies were noted, additional left-arm angiography was conducted to assess the feasibility of left-sided TRA during future therapy.

Results: The mean age of the participants was 67.9 years, and 19 were women. Minor and transient events included puncture-site pain (3.9%) and transient forearm numbness (3.9%), and analgesics were used in 5.9% of cases. There was no subcutaneous hematoma or hemorrhagic event requiring intervention. On angiography during neurointerventional treatment, one (2.0%) patient presented with mild stenosis at the brachial puncture site, and no procedure-related issues were observed. No pseudoaneurysm, arteriovenous fistula, or hematoma with swelling was detected.

Conclusions: The use of the TBA strategy with a 4-Fr sheath in preoperative diagnostic angiography preserves radial artery patency while allowing anatomical evaluation. Hence, this method is a relatively safe and feasible option for centers adopting TRA-based neurointervention.