• Evan Luther, David McCarthy, Jasmine Hect, Joshua Burks, Victor M Lu, Vaidya Govindarajan, Ian A Ramsay, Hunter King, Michael A Silva, Ahmed Abdelsalam, Dileep Yavagal, Eric Peterson, Robert M Starke, and Jacques Morcos.
• Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
• Neurosurgery. 2023 Aug 1; 93 (2): 366372366-372.

BackgroundDespite studies continuing to demonstrate the utility of transradial access (TRA) in neuroangiography, minimal data exist regarding predictors of TRA failure. Furthermore, although many patients with moyamoya disease/syndrome will require life-long angiographic evaluation, even less has been reported on the usage of TRA in this population.ObjectiveTo perform a matched analysis at our high-volume moyamoya center to determine predictors of TRA failure in these patients.MethodsA total of 636 patients undergoing TRA for neuroangiography were identified from 2018 to 2020. Demographic and angiographic characteristics including radial artery spasm (RAS), radial anomalies, and access site conversion were compared between patients with moyamoya and the rest of the cohort. A 4:1 matched analysis, based on age and sex, was also performed to eliminate confounding variables.ResultsPatients with moyamoya were younger (40 vs 57 years, P < .0001), had smaller radial diameters (1.9 vs 2.6 mm, P < .0001), more commonly had a high brachial bifurcation (25.9% vs 8.5%, P = .008), more frequently experienced clinically significant RAS (40% vs 8.4%, P < .0001), and more often required access site conversion (26.7% vs 7.8%, P = .002). Increasing age was associated with less TRA failures in patients with moyamoya (odds ratio = 0.918) but more failures in the rest of the cohort (odds ratio = 1.034). In the matched analysis, patients with moyamoya continued to experience more radial anomalies, RAS, and access site conversions.ConclusionPatients with moyamoya, when controlling for age and sex, have higher rates of TRA failure during neuroangiography. Increasing age in Moyamoya is inversely correlated with TRA failures suggesting that younger patients with moyamoya are at higher risk of extracranial arteriopathy.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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