Objective To apply high-frequency ultrasound in patients who underwent combined cerebral coronary angiography by transradial access (TRA) to observe surgery and complications and understand the safety of TRA and surgical complications and the role of preoperative ultrasound evaluation. Methods Patients who underwent cerebral coronary angiography were prospectively enrolled in the study, and they were divided into a ultrasound assessment group and a non-assessment group. The basic information, upper extremity artery condition, and surgical information of the patients in the two groups were collected. The postoperative complications were evaluated, comparison was made between the two groups, and the correlation between related factors and surgical complications was analyzed. Results The puncture time in the ultrasound assessment group was shorter than that in the non-assessment group (P<0.05). There were no statistically significant differences in baseline data, upper limb artery conditions, and surgical complications between the two groups (P>0.05). There was a certain correlation between intraoperative radial artery spasm and hypertension (r=0.157,P<0.05). There was a certain correlation between postoperative arterial dissection and upper limb artery stenosis or occlusion (r=0.161, P<0.05). Postoperative radial artery occlusion was related to the radial artery inner diameter (r=-0.159, P<0.05) and radial artery excessive tortuosity (r=0.242, P<0.05).Conclusion It is safe and feasible to complete cerebral coronary angiography by transradial access at one time. The abnormal anatomy of upper extremity arteries increases the complications to some extent. Preoperative ultrasound is used to fully assess the anatomy of the upper extremity arteries which provides a basis for clinical decision-making and device selection for surgeons, will help to reduce the adverse effects of anatomical abnormalities on surgery