Background 

Transradial access (TRA) has become an integral component of contemporary neurointerventional practice, offering reduced access site complications and improved patient comfort compared with transfemoral approaches. However, anatomical constraints intrinsic to the radial route continue to define the physiological boundaries of radial first strategies, underscoring the need for guide catheters that balance navigability, support, and access site safety. The Benchmark BMX81 guide catheter represents a radial compatible platform designed to address these challenges, but large multicenter data within a standardized radial first framework remain limited.

Methods 

We conducted a multicenter, retrospective observational study across nine high volume European neurointerventional centers. Adult patients undergoing neuroendovascular procedures in which the BMX81 was selected as the primary guide catheter via a radial first strategy were included. Technical success was defined as completion of the planned procedure using transradial access. Access conversion and procedural abortion were analyzed within a safety oriented radial first framework. Complications were assessed descriptively.

Results 

A total of 300 patients (mean age 64 years; 58.3% women) were included. Technical success was achieved in 289 cases (96.3%). Radial-to-femoral access conversion occurred in four cases (1.3%), and seven procedures (2.3%) were aborted. Neither conversion nor procedural abortion was attributable to intrinsic guide catheter failure but consistently reflected predefined anatomical constraints, including unfavorable great vessel geometry and severe proximal tortuosity. Access related complications were infrequent and predominantly minor, including radial artery spasm (1.7%), minor forearm hematoma (5.3%), and asymptomatic radial artery occlusion (3.3%). No guide catheter entrapment, procedure related stroke, or mortality was observed.

Conclusions 

Within a mature radial first neurointerventional strategy, the BMX81 demonstrated high technical success and a favorable safety profile across a broad spectrum of procedures. These findings support a strategy driven interpretation of transradial outcomes, in which guide catheter performance reflects the interaction between anatomy, access strategy, and device design rather than an isolated technical attribute. The BMX81 appears to be a reliable platform when applied within anatomically informed radial first practice.