A scoring system for predicting the difficulty of trans-radial cerebral angiography

Background Despite the growing adoption of trans-radial access in neurointervention, no validated scoring system currently exists to predict procedural difficulty of trans-radial cerebral angiography. Purpose To develop and validate a scoring system for pre-procedural assessment of trans-radial cerebral angiography difficulty. Materials and methods We recruited consecutive patients who underwent trans-radial cerebral angiography between June 2024 and April 2025. Patients were grouped according to the modified operator rating scale based on previous literature and assigned to either the easy or hard group. Baseline characteristics, imaging measurements, procedural information, and complications were recorded. The scoring system was developed through multivariable logistic regressions. Results Forty-nine patients were included in this study (mean age, 63.53 ± 1.57 years, 31 men). The easy group included 26 patients, and the hard group included 23 patients. Independent predictors of trans-radial cerebral angiography difficulty were diameter of aortic arch at apex ≥28 mm (OR = 4.651, 95% CI = 1.099–19.658, p = 0.037) and total number of vascular angulations (OR = 3.680, 95% CI = 1.441–9.395, p = 0.006). A scoring system (range: 0–5 points) was derived, with scores ≥ 3 indicating high difficulty. Conclusion Patients with a larger diameter of aortic arch, and more tortuous vessels have a higher difficulty of trans-radial cerebral angiography. This scoring system may be useful for predicting difficulty in pre-procedural trans-radial cerebral angiography.