Objectives To compare radiation exposure between transradial (TRA) and transfemoral (TFA) access and identify treatment-related factors associated with radiation exposure in endovascular treatment of intracranial aneurysms. Materials and methods This retrospective single-center study analyzed consecutively treated patients receiving endovascular aneurysm treatment (EAT) from May 2023 to April 2025 at the University Medical Center Hamburg-Eppendorf. EAT was performed by nine experienced board-certified neuroradiologists. The primary outcome was the radiation exposure defined as dose area product (DAP) (Gy·cm2). In addition to access route (TRA vs. TFA), patient-related (e.g. age, gender, aneurysm location) and procedure-related (e.g., interventionalist, incidental vs. symptomatic, used device) characteristics were analyzed with regard to radiation exposure using uni- and multivariable linear regression analysis. Results A total of 209 patients (156 female, 53 male; median age 59 [51–68]) were analyzed. Median DAP was 72.2 (51.6–96.7). Multivariable linear regression analyses revealed that radiation exposure did not differ significantly between TRA and TFA (β = 8.13 [−3.79 to 20.01]; p = 0.18). Stent-assisted coiling (β = 55.82 [34.91–76.74]; p < .001) and female gender (β = −14.95 [−27.5 to −22.41]; p = 0.02) were associated with increased DAP. Further patient- and procedure-related variables were not significantly associated with radiation exposure. Conclusion In this study, the choice between TRA and TFA had no significant impact on radiation exposure during endovascular aneurysm treatment. Stent-assisted coiling was independently associated with increased radiation exposure during endovascular treatment of intracranial aneurysms. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Understanding and minimizing radiation exposure in endovascular aneurysm treatment is essential, as the increasing use of transradial access necessitates comparison with the established transfemoral route. <Emphasis Type="BoldItalic">Findings</Emphasis> Radiation exposure did not differ between transradial and transfemoral access, while higher doses were independently associated with stent-assisted coiling procedures of increased complexity. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Our findings support the safety of transradial access regarding radiation exposure, allowing operators to select the most suitable access route based on patient anatomy and preference without increasing radiation risk. Graphical Abstract

Radiation exposure in transradial versus transfemoral access in endovascular treatment of intracranial aneurysms

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2026年5月4日

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Gregor Peter,
Christian Thaler,
Luca Meucci,
Felix Schlicht,
Matthias Bechstein,
Vincent Geest,
Helge Kniep,
Maxim Bester,
Jens Fiehler,
Lukas Meyer

摘要

Objectives

To compare radiation exposure between transradial (TRA) and transfemoral (TFA) access and identify treatment-related factors associated with radiation exposure in endovascular treatment of intracranial aneurysms.

Materials and methods

This retrospective single-center study analyzed consecutively treated patients receiving endovascular aneurysm treatment (EAT) from May 2023 to April 2025 at the University Medical Center Hamburg-Eppendorf. EAT was performed by nine experienced board-certified neuroradiologists. The primary outcome was the radiation exposure defined as dose area product (DAP) (Gy·cm²). In addition to access route (TRA vs. TFA), patient-related (e.g. age, gender, aneurysm location) and procedure-related (e.g., interventionalist, incidental vs. symptomatic, used device) characteristics were analyzed with regard to radiation exposure using uni- and multivariable linear regression analysis.

Results

A total of 209 patients (156 female, 53 male; median age 59 [51–68]) were analyzed. Median DAP was 72.2 (51.6–96.7). Multivariable linear regression analyses revealed that radiation exposure did not differ significantly between TRA and TFA (β = 8.13 [−3.79 to 20.01]; p = 0.18). Stent-assisted coiling (β = 55.82 [34.91–76.74]; p < .001) and female gender (β = −14.95 [−27.5 to −22.41]; p = 0.02) were associated with increased DAP. Further patient- and procedure-related variables were not significantly associated with radiation exposure.

Conclusion

In this study, the choice between TRA and TFA had no significant impact on radiation exposure during endovascular aneurysm treatment. Stent-assisted coiling was independently associated with increased radiation exposure during endovascular treatment of intracranial aneurysms.

Key Points

Question Understanding and minimizing radiation exposure in endovascular aneurysm treatment is essential, as the increasing use of transradial access necessitates comparison with the established transfemoral route.

Findings Radiation exposure did not differ between transradial and transfemoral access, while higher doses were independently associated with stent-assisted coiling procedures of increased complexity.

Clinical relevance Our findings support the safety of transradial access regarding radiation exposure, allowing operators to select the most suitable access route based on patient anatomy and preference without increasing radiation risk.

Graphical Abstract