Transradial Uterine Artery Embolization Complicated by Stroke

Over the last few decades, transradial access (TRA) has become an increasingly popular approach for angiography and intervention. Interventional radiologists (IRs) trained in the last decade are more likely to have gained experience with TRA during training and observed the advantages inherent to this technique including faster ambulation postprocedure, increased patient comfort, and decreased bleeding and vascular complications.1–5 However, some IRs remain reluctant to use TRA rather than transfemoral access (TFA), due to the learning curve and potential risks.6 With standard anatomy and proper TRA technique, the wire and catheter cross from the left subclavian into the descending aorta. In cases with challenging anatomy, additional manipulation may be necessary in the aortic arch, posing a rare but devastating risk of stroke. Herein, we report on a premenopausal female who underwent elective, outpatient uterine artery embolization (UAE) through TRA, which was complicated by a postprocedural stroke. Data on stroke rates during catheter-based intervention are reviewed, we discuss the existing literature comparing TRA versus TFA, and suggest approaches to management of stroke in this setting.