Transradial versus transfemoral access routes for diagnostic cerebral angiography: a large single-center comparative cost-analysis study

J Neurosurg. 2023 Nov 17;140(5):1328-1334. doi: 10.3171/2023.9.JNS23941. Print 2024 May 1.


Objective: Recently, the transradial (TR) approach has become a common alternative because of its safety profile and increased patient satisfaction compared with the transfemoral (TF) route. Both routes are associated with their respective associated costs, and differences typically emerge on the basis of patient anatomy, operator expertise, and occurrence of complications. The authors' objective was to compare the overall costs of diagnostic cerebral angiography via both routes and to shed light on the individual equipment costs of each route.

Methods: This retrospective single-center study of 926 elective diagnostic angiograms was performed between December 2019 and March 2022.

Results: The study comprised of 314 and 612 angiograms performed through the TF and TR routes, respectively. A significantly greater proportion of female patients were included in the TF cohort (79.3% vs 67.8%, p < 0.001), and most other demographic characteristics and baseline modified Rankin Scale scores were comparable between cohorts. The overall cost of patients utilizing the TR route was comparable to that of the TF route (mean ± SD $12,591.80 ± $19,128.00 vs $12,789.50 ± 18,424.00, p = 0.88). However, the median cost of catheters was significantly higher in TR group ($55.20 vs $12.40, p = 0.03), while the median costs of closure devices ($87.00 vs $20.20 p < 0.001) and sheaths ($44.60 ± 11.3 vs $41.10 ± 3.10, p < 0.001) were significantly higher in the TF group.

Conclusions: Overall, the authors' study showed that the TR approach can be a less expensive option for patients undergoing diagnostic cerebral angiography, especially if complications occur. Future studies may corroborate these findings and potentially lead to the adoption of TR as a low-cost, efficient, gold-standard technique for cerebral angiography.

Keywords: cerebral angiography; cost efficiency; transfemoral; transradial; vascular disorders.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cerebral Angiography* / economics
  • Cerebral Angiography* / methods
  • Costs and Cost Analysis
  • Female
  • Femoral Artery* / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Radial Artery* / diagnostic imaging
  • Retrospective Studies