Utility of left wrist arterial access for neuroendovascular intervention and diagnostic cervicocerebral angiography: A single-center experience.

BACKGROUND: Transradial access is increasingly used in neuroendovascular procedures because it improves patient comfort and reduces access-site complications compared with transfemoral approaches. Most reported experience concerns right radial access, and the role of left wrist access is less well characterized. We evaluated left wrist access for diagnostic cerebral angiography and neuroendovascular intervention. METHODS: We retrospectively reviewed patients who underwent neuroendovascular procedures using left wrist access at a single university health system between April 2019 and August 2025. Procedural success required catheterization of all intended vessels and, for interventions, completion of the planned treatment. RESULTS: 141 patients underwent procedures via left wrist access: 76 diagnostic angiograms (53.9%) and 65 interventions (46.1%). Pathology was predominantly posterior circulation in both cohorts. Left vertebral artery anatomy was the primary indication, and the left vertebral artery was the most frequently catheterized vessel. Procedural success was 76 of 76 (100%) for diagnostic procedures and 62 of 65 (95.4%) for interventions; the three aborted interventions were stopped for anatomical reasons unrelated to access. Median examination and fluoroscopy durations were 80 and 8.1 min for diagnostic procedures and 131 and 38.3 min for interventions. No access-site complications requiring intervention occurred. CONCLUSIONS: Left wrist arterial access was successful for cervicocerebral angiography and posterior fossa intervention, its main limitation being the absence of reliable guide catheter support for anterior circulation intervention. Patients were selected for this route when their anatomy favored it, so these findings apply to a selected population and do not establish absolute equivalence or superiority to other routes.