Prospective Multicenter Observational Study of Silent Brain Infarction following Transradial Hepatic Intervention (The MOSAIC Study).

Purpose: To investigate the incidence and risk factors of silent brain infarction following transradial hepatic interventional procedures.

Materials and methods: In this multicenter prospective observational study, 57 patients scheduled for transradial hepatic intervention underwent preprocedural and postprocedural magnetic resonance (MR) imaging. The study was divided into 2 periods: August-December 2022 (former group) and June-December 2023 (latter group). In the latter period, selection criteria were modified to include only patients with a left subclavian artery (SCA) angle of >50°, and the protocol was revised to incorporate strict heparinization and continuous catheter flushing. The primary end point was the incidence of silent brain infarction, and associated risk factors were analyzed.

Results: Among 57 registered patients, 55 underwent transradial access (TRA). Silent brain infarction was detected in 9 patients (16.4%), with no symptomatic cerebral infarction. The incidence reduced significantly in the latter compared with that in the former group (2.9% vs 40%; P < 0.001). Univariate analysis in the former group demonstrated prolonged catheterization time from the left SCA to descending thoracic aorta as a significant risk factor (575.0 seconds [SD ± 536.2] vs 57.9 seconds [SD ± 59.4]; P = .008), with a cutoff value of 58 seconds (sensitivity, 0.727; specificity, 0.875). Moreover, patients with a left SCA angle of ≤50° demonstrated a significantly higher incidence of silent brain infarction (P = .049).

Conclusions: This study demonstrated that transradial hepatic intervention was associated with a 40% incidence of silent brain infarction, which may be reduced by protocols limiting TRA to patients with favorable anatomy and incorporating continuous heparinization and catheter perfusion.