Utility of Bilateral Upper Extremity Arterial Access for Complex Neurovascular Intervention and Diagnostic Cervicocerebral Angiography: A Unique Single-Center Experience.

Objective: Wrist-based access for cervicocerebral angiography and neurovascular interventions is increasingly adopted as an alternative to transfemoral access, offering lower complication rates and faster recovery. In select cases, dual arterial access facilitates navigation of complex anatomy and the use of multiple devices. However, evidence supporting bilateral wrist access remains limited. We report our institutional experience (University of Pennsylvania Health System) with this approach. Methods: We retrospectively reviewed consecutive diagnostic and interventional neurovascular procedures performed using bilateral wrist access across a single university health system (September 2019-July 2025). Demographic, clinical, and procedural data were summarized, with a focus on technical considerations and outcomes. Results: Twenty procedures were performed, including 7 diagnostic and 13 interventional cases. Bilateral radial access was used in 16 cases, and ulnar access in 4. Median procedure time was 117 min for diagnostic cases and 236 min for interventional cases. The most common indication for bilateral access in diagnostic procedures was to facilitate anatomic reach for vertebral artery catheterization, while a transcirculation approach was the primary indication in interventional cases. Target vessel catheterization was achieved in 19 of 20 cases (95%). No major complications occurred. One case required conversion to femoral access due to unfavorable working angles across the aortic arch. One self-limited radial artery wire microperforation was successfully managed with catheter tamponade and conversion to ulnar access. On systematic review of follow-up imaging, 1 symptomatic radial artery occlusion was identified (1/20; 5%), managed conservatively without functional sequelae; no other access-site complications were observed. Conclusion: Bilateral wrist access is a safe and technically feasible alternative access strategy in carefully selected cases for cervicocerebral angiography and neurovascular interventions. With appropriate planning, this technique may serve as a selective alternative access strategy for complex procedures requiring dual arterial access, particularly posterior circulation and transcirculation interventions.