For decades, when patients needed a catheter-based procedure on the blood vessels of the brain—whether a diagnostic angiogram or a life-saving endovascular treatment—the standard approach involved inserting a catheter through a large artery in the groin. While effective, this approach required patients to lie flat for hours afterward, carried a risk of bleeding at the access site, and was often the aspect of the procedure patients dreaded most.
Today, there is a better way. A growing number of neurovascular procedures can now be performed through the radial artery in the wrist—and even the ulnar artery—offering patients a safer, more comfortable experience with faster recovery.
What Is Transradial Access?
Transradial access simply means using the artery at the wrist rather than the groin as the entry point for catheter-based procedures. The same microcatheters, coils, stents, and devices used in traditional groin-based procedures are navigated up through the arm and into the blood vessels of the brain. The difference is where the journey begins—and for patients, that difference is significant.
Why the Wrist?
The advantages of wrist-based access are meaningful for patients:
- Faster recovery: After a groin-based procedure, patients typically must lie flat for four to six hours to prevent bleeding at the access site. With wrist access, a small pressure band is applied and patients can typically sit up and walk immediately after the procedure.
- Lower complication rates: The radial and ulnar arteries are smaller and more superficial than the femoral artery, which means bleeding complications are significantly less common. This is especially beneficial for patients on blood-thinning medications.
- Greater comfort: Patients consistently report that procedures performed through the wrist are far more comfortable than those performed through the groin. There is less pain, less anxiety, and a faster return to normal activity.
- Same-day discharge: Many diagnostic angiograms and some interventional procedures performed through the wrist can be done on an outpatient basis, with patients going home the same day.
From Radial-First to Wrist-First
While transradial access has been standard practice in cardiology for years, its adoption in neurosurgery and neurointerventional surgery has been more recent. I have been among the early adopters of radial-first and wrist-first strategies in neurovascular surgery, performing diagnostic cerebral angiograms and complex endovascular interventions—including aneurysm treatments, embolizations, and carotid stenting—through the wrist.
More recently, we have extended this approach even further. Our published research has demonstrated the feasibility and safety of using the ulnar artery (also in the wrist, on the opposite side from the radial artery) as an access point for neurointerventional procedures. This “wrist-first” philosophy provides additional options for patients and further reduces the need for groin access.
We have also published the largest single-center experience using upper extremity veins for transvenous neurointerventional procedures—meaning that even procedures requiring venous access (such as treatment of dural fistulas or venous sinus stenting) can now be performed through the arm rather than the groin.
What Procedures Can Be Done Through the Wrist?
A wide and growing range of neurovascular procedures can now be performed via wrist access:
- Diagnostic cerebral angiography
- Brain aneurysm treatment (coiling, flow diversion, intrasaccular devices)
- Embolization of arteriovenous malformations and dural fistulas
- Carotid artery stenting and transcarotid revascularization (TCAR)
- Acute stroke thrombectomy
- Venous sinus stenting for idiopathic intracranial hypertension
- Intraoperative angiography during open neurosurgical procedures
Is Wrist Access Right for You?
Not every patient or every procedure is suited for wrist access. Certain complex cases may still require groin-based access, and some patients may have vascular anatomy that makes wrist access technically challenging. The key is working with a surgeon who is experienced in all access strategies and can select the optimal approach for each individual patient and procedure.
“Our goal is always to give patients the best possible outcome with the least possible discomfort. Wrist-based access is one of the most meaningful advances in patient experience that I’ve seen in my career.” — Dr. Omar Choudhri
If you have an upcoming neurovascular procedure and want to learn more about minimally invasive wrist-based access, contact us to discuss your options.
