Correlation of CT Angiography (CTA) to Digital Subtraction Angiography in Carotid Stenosis (CS) with Real-world Assessment of Overestimation of CS on CTA.

PURPOSE: Computerized tomography angiography (CTA) is a well-established diagnostic modality for carotid stenosis (CS). However, false-positive CTA results may expose patients to unnecessary procedural complications in cases where surgical intervention is not warranted. We aim to assess the correlation of CTA to DSA in CS and characterize patients who were referred for intervention based on CTA and did not require it based on DSA. METHODS: We retrospectively reviewed 186 patients who underwent carotid angioplasty and stenting following pre-procedural CTA at our institution from April 2017 to December 2022. RESULTS: Twenty-one of 186 patients (11.2%) were found to have <50% carotid stenosis on DSA (discordant group). Severe plaque calcification on CTA was associated with a discordant degree of stenosis on DSA (LR+ = 7.4). Among 186 patients, agreement between the percentage of stenosis from CTA and DSA was weak-moderate (r2 = 0.27, p <0.01). Among concordant pairs, we found moderate-strong agreement between CTA and DSA (adj r2=0.37)(p<0.0001). Of 186 patients, 127 patients had CTA stenosis of ≥70%, and 59 had CTA of 50-69%. Correlation between CTA and DSA in severe CTA stenosis was weak (r2=0.11, p <0.01). CONCLUSION: In patients with stenosis found on CTA, over 88% also had stenosis on DSA, with this PPV in line with previous studies. The percent-stenosis value from CTA and DSA was weakly correlated but does not affect clinical judgement of stenosis overall. Severe calcification found on CTA may potentially indicate non-stenosis on DSA.

The Use of the Scepter Dual-Lumen Balloon Catheter for Trans-Arterial Onyx Embolization of Cranial Dural Arteriovenous Fistulas.

BACKGROUND: Dual lumen balloon microcatheters allow for controlled anterograde flow of Onyx while providing proximal flow arrest, thereby obviating the need for a second microcatheter or Onyx plug formation. OBJECTIVE: To assess the safety and efficiency of the Scepter dual-lumen balloon microcatheter in trans arterial Onyx embolization of intracranial DAVFs. METHODS: This is a retrospective study of 36 patients with cranial DAVFs in which a Scepter balloon microcatheter was used between 2016 and 2023. RESULTS: Our study comprised 36 patients, mostly male (n=23, 63.8%) with a mean age of 60.8 years. Most DAVFs were located in the occipital lobe (n=24, 66.7%) and 50% had external carotid artery supply from the occipital artery. 18 (50%) of DAVFs were Cognard type III and IV, respectively. 33.3% (n= 12) of DAVFs drained into the transverse sigmoid junction, and 27.7% (n= 10) had direct cortical venous drainage into supratentorial or posterior fossa veins. Complete occlusion was obtained in 22 (61.1%) patients while partial occlusion was observed in 14 (38.9%) patients. 1 (2.8%) patient developed a retroperitoneal hematoma. At final follow-up complete occlusion was observed in 21 (77.8%) and partial occlusion was observed in 8 (22.2%). Recurrence was observed in 4/30 (13.3%) patients and retreatment was required in 6 (18.75%) cases. CONCLUSION: At mid-term follow-up, our study showed low morbidity and modest complete occlusion rates using the Scepter for trans arterial Onyx embolization of high grade DAVFs.

Dural Arteriovenous Fistula.

Dural arteriovenous fistulas are rare cerebrovascular lesions arising from abnormal connections between an artery and a vein. Though rare, high-grade aggressive lesions can cause hemorrhagic events and non-hemorrhagic neurologic deficits if left untreated. Treatment options vary based on angioarchitecture, location, and patient characteristics and range from conservative observation to palliative treatment, radiosurgery, endovascular embolization, and open surgery. The main goal of treatment is to obliterate flow through the abnormal connection and prevent further arterial flow to the venous system.

Transarterial Embolization of Intracranial Dural Arteriovenous Fistulas Cognard Type V With Direct Drainage Into the Perimedullary Veins: Case Report and Literature Review.

BACKGROUND AND IMPORTANCE: Cognard type V fistula (CVF) is a rare type of dural arteriovenous fistula characterized by spinal perimedullary venous drainage. Owing to the lack of pathognomonic findings, misdiagnosis is common. Patients often undergo multiple spinal angiograms negative for spinal vascular malformations. Digital subtraction angiography is the gold standard diagnostic tool. The preferred treatment option is endovascular management with embolization through a transarterial, transvenous, or combined approach. Other options include open surgery, stereotactic radiosurgery, or a combination of both. CLINICAL PRESENTATION: The patient from case # 1 presented with progressive weakness and hypoesthesia in the bilateral lower extremities, with urinary and bowel incontinence. The DSA identified a CVF fed by the meningohypophyseal trunk and a draining perimedullary vein. Embolization with 0.1 ccs of Onyx-18 was performed with complete fistula occlusion. The patient from case # 2 developed bilateral lower extremity weakness, diffuse numbness, and urinary incontinence. The DSA showed a CVF fed by tributaries from the ascending pharyngeal artery and posterior meningeal artery branches of the V3 segment, draining into a perimedullary vein. Embolization with 0.3 cc of Onyx-18 was performed with 100% occlusion of the fistula. A 1-year follow-up angiogram confirmed complete fistula occlusion. Both patients consented to the procedure. CONCLUSION: Even if a patient only presents symptoms of myelopathy, CVF should be considered. Herein, we present 2 cases of CVF with direct drainage into the perimedullary veins which presented exclusively with myelopathy syndrome and describe treatment with trasarterial embolization with Onyx.

The Artificial Intelligence Revolution in Stroke Care: A Decade of Scientific Evidence in Review.

BACKGROUND: The emergence of artificial intelligence (AI) has significantly influenced the diagnostic evaluation of stroke and has revolutionized acute stroke care delivery. The scientific evidence evaluating the role of AI, especially in areas of stroke treatment and rehabilitation is limited but continues to accumulate. We performed a systemic review of current scientific evidence evaluating the use of AI in stroke evaluation and care and examined the publication trends during the past decade. METHODS: A systematic search of electronic databases was conducted to identify all studies published from 2012 to 2022 that incorporated AI in any aspect of stroke care. Studies not directly relevant to stroke care in the context of AI and duplicate studies were excluded. The level of evidence and publication trends were examined. RESULTS: A total of 623 studies were examined, including 101 reviews (16.2%), 9 meta-analyses (1.4%), 140 original articles on AI methodology (22.5%), 2 case reports (0.3%), 2 case series (0.3%), 31 case-control studies (5%), 277 cohort studies (44.5%), 16 cross-sectional studies (2.6%), and 45 experimental studies (7.2%). The highest published area of AI in stroke was diagnosis (44.1%) and the lowest was rehabilitation (12%). A 10-year trend analysis revealed a significant increase in AI literature in stroke care. CONCLUSIONS: Most research on AI is in the diagnostic area of stroke care, with a recent noteworthy trend of increased research focus on stroke treatment and rehabilitation.

Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study.

BACKGROUND: Moyamoya is a chronic occlusive cerebrovascular disease of unknown etiology causing neovascularization of the lenticulostriate collaterals at the base of the brain. Although revascularization surgery is the most effective treatment for moyamoya, there is still no consensus on the best surgical treatment modality as different studies provide different outcomes. OBJECTIVE: In this large case series, we compare the outcomes of direct (DR) and indirect revascularisation (IR) and compare our results to the literature in order to reflect on the best revascularization modality for moyamoya. METHODS: We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines of moyamoya affected hemispheres treated with DR and IR surgeries across 13 academic institutions predominantly in North America. All patients who underwent surgical revascularization of their moyamoya-affected hemispheres were included in the study. The primary outcome of the study was the rate of symptomatic strokes. RESULTS: The rates of symptomatic strokes across 515 disease-affected hemispheres were comparable between the two cohorts (11.6% in the DR cohort vs 9.6% in the IR cohort, OR 1.238 (95% CI 0.651 to 2.354), p=0.514). The rate of total perioperative strokes was slightly higher in the DR cohort (6.1% for DR vs 2.0% for IR, OR 3.129 (95% CI 0.991 to 9.875), p=0.052). The rate of total follow-up strokes was slightly higher in the IR cohort (8.1% vs 6.6%, OR 0.799 (95% CI 0.374 to 1.709) p=0.563). CONCLUSION: Since both modalities showed comparable rates of overall total strokes, both modalities of revascularization can be performed depending on the patient's risk assessment.

Endovascular Embolization for Epistaxis: A Single Center Experience and Meta-Analysis.

The optimal treatment for intractable epistaxis is still controversial. Various studies have demonstrated high success rates and low complication rates for endovascular embolization. Herein, the authors report an institutional experience and meta-analysis in terms of efficacy and safety of endovascular embolization of intractable epistaxis. This was a retrospective observational study of 35 patients with epistaxis who underwent 40 embolization procedures between 2010 and 2023. The primary outcome was immediate success defined by immediate cessation of epistaxis at the end of the procedure. Immediate success was achieved in most of the procedures (39, 97.5%). During follow-up, three (7.5%) patients experienced a rebleed. Forty-one studies from 3595 articles were identified for inclusion in the meta-analysis and comprised 1632 patients. The mean pooled age was 57.5 years (95% CI: 57.2-57.8) and most patients were males (mean: 70.4, 95% CI: 69.8-71.0). Immediate success was achieved at a pooled mean of 90.9% (95% CI: 90.4-91.4) and rebleeding was observed at a pooled mean of 17% (95% CI: 16.5-17.5). In conclusion, endovascular embolization proved to be both safe and effective in treating intractable epistaxis carrying a low risk of post-operative stroke.

Predictors of Transfemoral Access Site Complications in Neuroendovascular Procedures: A large Single-Center Cohort Study.

OBJECTIVE: The transfemoral (TF) route has historically been the preferred access site for endovascular procedures. However, despite its widespread use, TF procedures may confer morbidity as a result of access site complications. The aim of this study is to provide the rate and predictors of TF access site complications for neuroendovascular procedures. METHODS: This is a single center retrospective study of TF neuroendovascular procedures performed between 2017 and 2022. The incidence of complications and associated risk factors were analyzed across a large cohort of patients. RESULTS: The study comprised of 2043 patients undergoing transfemoral neuroendovascular procedures. The composite rate of access site complications was 8.6 % (n = 176). These complications were divided into groin hematoma formation (n = 118, 5.78 %), retroperitoneal hematoma (n = 14, 0.69 %), pseudoaneurysm formation (n = 40, 1.96 %), and femoral artery occlusion (n = 4, 0.19 %). The cross-over to trans radial access rate was 1.1 % (n = 22). On univariate analysis, increasing age (OR=1.0, p = 0.06) coronary artery disease (OR=1.7, p = 0.05) peripheral vascular disease (OR=1.9, p = 0.07), emergent mechanical thrombectomy procedures (OR=2.1, p < 0.001) and increasing sheath size (OR=1.3, p < 0.001) were associated with higher TF access site complications. On multivariate analysis, larger sheath size was an independent risk factor for TF access site complications (OR=1.8, p = 0.02). CONCLUSION: Several pertinent factors contribute towards the incidence of TF access site complications. Factors associated with TF access site complications include patient demographics (older age) and clinical risk factors (vascular disease), as well as periprocedural factors (sheath size).

Real world implementation of flow cytometric monocyte subset partitioning for distinguishing chronic myelomonocytic leukaemia from other causes of monocytosis.

Monocyte subset partitioning by flow cytometry may be a useful tool in distinguishing chronic myelomonocytic leukaemia (CMML) from other causes of monocytosis, however there has been varying success in real world implementation. Additionally, current assays require an individual tube for analysis despite significant overlap in antibodies used in routine T and NK cell analysis. The objective of this study was to validate a flow cytometry assay for the enumeration of monocyte subsets in our community-based laboratory and compare this to a hybrid panel allowing analysis of monocytes, T cells and NK cells in a single tube. Monocyte subset analysis was performed on peripheral blood samples of patients with monocytosis at the time of bone marrow biopsy or transient monocytosis in the setting of bacteraemia. Cut-offs of >94% classical and <1.13% non-classical monocytes for distinguishing CMML were assessed. Classical monocytes were significantly higher, and non-classical monocytes significantly lower in CMML compared to other causes of monocytosis. The sensitivity and specificity of >94% classical monocytes were 73% [95% confidence interval (CI) 43-90%] and 89% (95% CI 75-96%) regardless of which panel was used. Non-classical monocytes of <1.13% had a sensitivity and specificity of 82% (95% CI 52-97%) and 83% (95% CI 68-92%) with the monocyte panel and 55% (95% CI 28-78%) and 89% (95% CI 75-96%) using the hybrid panel. We have found the estimation of the classical monocyte subset to be the most robust and repeatable variation of this assay with sensitivity and specificity that is clinically useful. A hybrid panel may provide an effective approach to implementing monocyte subsets into practice.

Atopic Dermatitis: A Common Pediatric Diagnosis That Is Not Just Another Rash.

Emergency nurse practitioners are expected to assess and manage a variety of patients. These patients may present with urgent care-type complaints to severe life-threatening illnesses or injuries. For some, dermatological problems can sometimes be just as challenging as a critically ill patient. Atopic dermatitis (AD) is one, if not, the most common chronic inflammatory disease. Its presentation can vary depending on the age of the patient, the patient's skin tone, and other comorbidities. Patients often seek emergency care related to the condition itself or associated complications. This article includes a review of the pathophysiology, clinical manifestations, and standard management of AD. Finally, the potential complications of AD are discussed. A better understanding of AD will allow emergency nurse practitioners to properly identify and treat this chronic condition, as well as its complications.

A complication of the transradial approach: thyrocervical trunk pseudoaneurysm with hemothorax.

The transradial approach has gained popularity in the neuroendovascular field after several studies proved its low rate of hemorrhagic and vascular-related complications in both diagnostic and therapeutic procedures. This is a case of a patient who presented for flow diversion treatment of an incidental left carotid ophthalmic aneurysm. The procedure was uneventful. Post-operatively, the patient's neurological exam and vital signs were normal, however the patient complained of abdominal and chest pain that worsened when lying down and improved when sitting up. Radiologic diagnosis confirmed the presence of a thyrocervical trunk pseudoaneurysm which was completely obliterated with Onyx 18 embolization. Thyrocervical trunk pseudoaneurysm formation is a rare complication of the transradial approach. Shedding the light on these entities is essential as symptoms vary in severity and presentation and necessitate swift diagnosis and treatment.

Long-Term Follow-Up of Cerebral Aneurysms Completely Occluded at 6 Months After Intervention with the Woven EndoBridge (WEB) Device: a Retrospective Multicenter Observational Study.

The Woven EndoBridge (WEB) device has been widely used to treat intracranial wide neck bifurcation aneurysms. Initial studies have demonstrated that approximately 90% of patients have same or improved long-term aneurysm occlusion after the initial 6-month follow up. The aim of this study is to assess the long-term follow-up in aneurysms that have achieved complete occlusion at 6 months. We also compared the predictive value of different imaging modalities used. This is an analysis of a prospectively maintained database across 13 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB device who achieved complete occlusion at first follow-up and had available long-term follow-up. A total of 95 patients with a mean age of 61.6 ± 11.9 years were studied. The mean neck diameter and height were 3.9 ± 1.3 mm and 6.0 ± 1.8 mm, respectively. The mean time to first and last follow-up was 5.4 ± 1.8 and 14.1 ± 12.9 months, respectively. Out of all the aneurysms that were completely occluded at 6 months, 84 (90.3%) showed complete occlusion at the final follow-up, and 11(11.5%) patients did not achieve complete occlusion. The positive predictive value (PPV) of complete occlusion at first follow was 88.4%. Importantly, this did not differ between digital subtraction angiography (DSA), magnetic resonance angiography (MRA), or computed tomography angiography (CTA). This study underlines the importance of repeat imaging in patients treated with the WEB device even if complete occlusion is achieved short term. Follow-up can be performed using DSA, MRA or CTA with no difference in positive predictive value.

A review of mechanical thrombectomy techniques for acute ischemic stroke.

Mechanical thrombectomy is established as standard of care in the management of acute ischemic stroke due to large vessel occlusion and evidence-based guidelines for mechanical thrombectomy have been defined. As research continues to further expand the eligibility criteria for thrombectomy and the number of thrombectomy procedures increase worldwide, there is also growing focus on innovation of thrombectomy devices, procedural techniques, and related outcomes. Thrombectomy primarily involves use of stent retrievers and distal aspiration techniques, but variations and different combinations of techniques have been reported. As this is a rapidly evolving area in stroke management, there is debate as to which, if any, of these techniques leads to improved clinical outcomes over another and there is a lack of data comparing them. In this review, currently published and distinct techniques of mechanical thrombectomy are described methodically along with illustrations to aid in understanding the subtle differences between the techniques. The perceived benefits of each variation are discussed.

Social Media and Neurosurgery: Insights from the Top 100 Neurosurgery Influencers on Twitter.

BACKGROUND: The rise in popularity of social media (SoMe) in medicine has created a powerful tool for the professional development and continued education of clinicians. Numerous benefits of SoMe exist; however, significant challenges concerning professionalism, confidentiality, and spread of misinformation may limit its usefulness. To understand the ways the top 100 Twitter influencers interact with SoMe, their views on SoMe, and its future in the medical field. METHODS: Literature was reviewed to obtain common concerns about SoMe in the medical field. A survey with 30 questions was sent to the top 100 Twitter influencers in the Neurosurgical field identified by Riccio et al. The survey assessed participant demographics, SoMe activity, stance toward SoMe, and views on the future of SoMe. RESULTS: Most participants were in the age group of 35-44 years (n = 23, 44.2%), resided in the United States (n = 39, 73.6%), have been in practice for 6-10 years (n = 14, 26.4%), and ranked Twitter as the mostly used platform (n = 37,72.6%). Per participant Reponses, 35 (66%) participants have taken a political stance on SoMe, 0 (0%) have gotten into any legal issues regarding a post shared on SoMe, 45 (84.9%) agreed/strongly agreed that SoMe is essential for networking and mentorship, and 49 (92.3%) agreed/strongly agreed that that SoMe will continue to play a major role in the medical field. CONCLUSIONS: Although SoMe has its advantages, several disadvantages render it a double-edged sword. Maximizing SoMe's benefits and minimizing its misuse will further strengthen its role in the medical field.

The Effect of COVID-19 Vaccines on Stroke Outcomes: A Single-Center Study.

BACKGROUND: One of the defining narratives of the COVID-19 pandemic has been the acceptance and distribution of vaccine. To compare the outcomes of COVID-19 positive vaccinated and unvaccinated stroke patients. METHODS: This is a single-center retrospective study of COVID-19-vaccinated and unvaccinated stroke patients between April 2020 and March 2022. All patients presenting with stroke regardless of treatment modalities were included. National Institutes of Health Stroke Scale was used to assess stroke severity. The primary outcome was functional capacity of the patients at discharge. RESULTS: The study cohort comprised 203 COVID-19 positive stroke patients divided into 139 unvaccinated and 64 fully vaccinated patients. At discharge, the modified Rankin scale score was significantly lower in the vaccinated cohort (3[1-4] vs. 4[2-5], odds ratio = 0.508, P = 0.011). At 3 months of follow-up, the median modified Rankin scale score was comparable between both cohorts. CONCLUSIONS: Although vaccination did not show any significant difference in stroke patient outcomes on follow-up, vaccines were associated with lower rates of morbidity and mortality at discharge among stroke patients during the pandemic.

Comparison of Flow-Redirection Endoluminal Device and Pipeline Embolization Device in the Treatment of Intracerebral Aneurysms.

BACKGROUND: The use of flow diverters for treating intracranial aneurysms has been widely used in the past decade; however, data comparing pipeline embolization device (PED; Medtronic Inc) and flow-redirection endoluminal device (FRED; MicroVention) in the treatment of intracranial aneurysms remain scarce. OBJECTIVE: To compare the outcomes of PED and FRED in the treatment of intracranial aneurysms. METHODS: This is a single-center retrospective review of aneurysms treated with PED and FRED devices. Patients treated with PED or FRED were included. Cases requiring multiple or adjunctive devices were excluded. Primary outcome was complete aneurysm occlusion at 6 months. Secondary outcomes included good functional outcome, need for retreatment, and any complication. RESULTS: The study cohort comprised 150 patients, including 35 aneurysms treated with FRED and 115 treated with PED. Aneurysm characteristics including location and size were comparable between the 2 cohorts. 6-month complete occlusion rate was significantly higher in the PED cohort (74.7% vs 51.5%; P = .017) but lost significance after inverse probability weights. Patients in the PED cohort were associated with higher rates of periprocedural complications (3.5% vs 0%; P = .573), and the rate of in-stent stenosis was approximately double in the FRED cohort (15.2% vs 6.9%; P = .172). CONCLUSION: Compared with PED, FRED offers modest 6-month occlusion rates, which may be due to aneurysmal and baseline patient characteristics differences between both cohorts. Although not significant, FRED was associated with a higher complication rate mostly because of in-stent stenosis. Additional studies with longer follow-up durations should be conducted to further evaluate FRED thrombogenicity.

Treatment of cerebral aneurysms with the FRED Jr flow-diverting stent: A case series and meta-analysis.

BACKGROUND: With the development of the Flow Re-Direction Endoluminal Device Junior (FRED Jr), treatment of distal aneurysms and/or aneurysms with small parent vessels has become a viable option. OBJECTIVES: To assess the efficacy and safety of FRED Jr in the treatment of distal aneurysms with small parent vessels. METHODS: This is a single center retrospective study and meta-analysis of patients treated with FRED Jr for intracranial aneurysms. The primary outcome was complete aneurysm occlusion at final follow-up. Secondary outcomes included stroke rates, mortality rates, need for retreatment and clinical outcomes. RESULTS: There were a total of 7 patients with 7 aneurysms treated with FRED Jr. Mean aneurysm neck, width, height, and parent artery diameter were 2.6 ± 0.8 mm, 3.1 ± 0.9 mm, 2.5 ± 1.0 mm, and 1.8 ± 0.6 mm respectively. The complete occlusion rate was 57.1 % at 6 months, and favorable outcome (mRS 0-2) was observed in all patients in follow-up. Stroke complication occurred in none of the patients. Seven studies from 1360 articles were identified for inclusion in the meta-analysis, comprising 227 patients with 244 aneurysms treated with FRED Jr. Mean aneurysm height, width, neck and parent artery diameter were 6.9 ± 3.3 mm (pooled=5.6 [<0.1-11.47] mm), 6.6 ± 2.2 mm (pooled=6.6 [4.2-9.1] mm), 4.4 ± 1.4 mm (pooled=4.1 [3.3 -4.9] mm), and 2.0 ± 0.2 mm (pooled=2.1 [1.7-2.5]), respectively. At final follow-up, the pooled complete occlusion and complication rates were 69.9 % and 0 %, respectively. CONCLUSION: FRED Jr demonstrated moderate efficacy and good safety in the treatment of distal aneurysms with small parent vessels at mid-term follow-up.

Patient and procedure selection for mechanical thrombectomy: Toward personalized medicine and the role of artificial intelligence.

Mechanical thrombectomy (MT) for ischemic stroke due to large vessel occlusion is standard of care. Evidence-based guidelines on eligibility for MT have been outlined and evidence to extend the treatment benefit to more patients, particularly those at the extreme ends of a stroke clinical severity spectrum, is currently awaited. As patient selection continues to be explored, there is growing focus on procedure selection including the tools and techniques of thrombectomy and associated outcomes. Artificial intelligence (AI) has been instrumental in the area of patient selection for MT with a role in diagnosis and delivery of acute stroke care. Machine learning algorithms have been developed to detect cerebral ischemia and early infarct core, presence of large vessel occlusion, and perfusion deficit in acute ischemic stroke. Several available deep learning AI applications provide ready visualization and interpretation of cervical and cerebral arteries. Further enhancement of AI techniques to potentially include automated vessel probe tools in suspected large vessel occlusions is proposed. Value of AI may be extended to assist in procedure selection including both the tools and technique of thrombectomy. Delivering personalized medicine is the wave of the future and tailoring the MT treatment to a stroke patient is in line with this trend.

Access Site Complications and Management of the Transradial Approach for Neurointerventions.

BACKGROUND: The transradial approach has increasingly been used for neurointerventions because of the improved safety profile compared with transfemoral. However, it is important to be aware of potential complications such as radial artery (RA) spasm, RA occlusion, pseudoaneurysm, extravasation, arteriovenous fistula, and wrist hematoma as well as their management. OBJECTIVE: To present our institution's experience with the prevention and management of local access site complications associated with the transradial approach for neuroendovascular interventions. METHODS: We conducted a retrospective analysis of a prospectively maintained database and identified 1524 consecutive neuroendovascular procedures performed using transradial access from April 2018 to February 2021. RESULTS: Among 1524 procedures, local transradial complications occurred in 1.7%. Major complications occurred at a rate of 1.2% including RA extravasation (0.3%), delayed RA occlusion (0.6%), pseudoaneurysm (0.1%), compartment syndrome (0.1%), infection (0.1%), and avulsion of the RA in 0.1% (1 of 1524) with no serious clinical consequence. Although RA occlusion is included in major complications, all cases were asymptomatic and did not require any intervention. Minor complications occurred at a rate of 0.5% including severe RA spasm (0.3%) and hematoma (0.3%). No patient in the cohort died or suffered from permanent disability from a complication related to the transradial approach. CONCLUSION: Transradial access for neurointervention has a low rate of local complications, particularly when taking appropriate prevention measures. Appropriate management of complications can prevent procedural failure and has low morbidity rates demonstrating the overall safety profile of transradial access even when complications occur.