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Background Transradial neurointervention (TRN) may reduce access-related complications associated with the transfemoral approach. The RIST guiding system was designed specifically for TRN, but the available clinical evidence has not been comprehensively evaluated.Objective To evaluate the effectiveness and safety of RIST-assisted TRN for intracranial neuroendovascular procedures.Methods We performed a systematic review and meta-analysis of studies reporting RIST-assisted TRN for intracranial interventions. MEDLINE, Cochrane Library, and Ichushi were searched through November 6, 2024. Primary outcomes were effectiveness (procedural success, successful navigation of the guiding system to the target vessel, and conversion from transradial to transfemoral access) and safety (access-site complications [ASC], hematoma, radial artery occlusion [RAO], and non-access-site complications).Results Five retrospective studies (462 cases) were included; four were single-arm and one included a non-RIST-assisted comparator. All studies used the initial 7-Fr RIST system (no 6-Fr data). Unruptured aneurysm treatment was the most common indication (51.7%). Pooled effectiveness outcomes were high: procedural success 95.3% and guiding system navigation success 96.0%, with a low conversion rate of 3.0% and no substantial heterogeneity. The pooled ASC rate was 6.9% with considerable heterogeneity driven by one study using a non-coated sheath; ASC was 1.1% with hydrophilic-coated sheaths versus 68.2% with non-coated sheaths. Hematoma, RAO, and non-access-site complications were each less than 5.0%. Symptomatic RAO occurred only in the non-coated sheath study (2/22).Conclusions Early clinical evidence suggests that RIST-assisted TRN achieves high procedural success with low conversion and an overall acceptable safety profile. Access-site complications appear strongly influenced by sheath selection, underscoring the need for standardized access protocols and larger prospective comparative studies, including contemporary lower-profile systems.Disclosures S. Yoshimura: 3; C; Daiichi Sankyo, Stryker, Medtronic, Kaneka Medics, Terumo, Johnson & Johnson.Abstract E-065 Figure 1Abstract E-065 Figure 2