Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment

Abstract

BackgroundThe transradial artery (TRA) approach for neuroendovascular procedures continues to gain popularity, but neurointerventionalists still lag behind interventional cardiologists in the adoption of a TRA-first approach. This study compares the complications and efficiency of the TRA approach to the standard transfemoral artery (TFA) approach at our institution during our initial phase of adopting a TRA-first approach.MethodsA retrospective analysis was performed on all consecutive neuroangiographic procedures performed at a large cerebrovascular center from October 1, 2018 to June 30, 2019. The standard TFA approach was compared with TRA access, with the primary outcome of complications analyzed via a propensity-adjusted analysis.ResultsA total of 1050 consecutive procedures were performed on 877 patients during this 9-month period; 206 (20%) procedures were performed via TRA and 844 (80%) via TFA. The overall complication rate was significantly higher with the TFA procedures than with the TRA procedures (7% (60/844) vs 2% (4/206), respectively; p=0.003). A propensity-adjusted analysis showed that the TFA approach was a significant risk factor for a complication (OR 3.6, 95% CI 1.3 to 10.2, p=0.01). However, the propensity analysis showed that fluoroscopy times were on average 4 min less for TFA procedures than for TRA procedures (p=0.003).ConclusionThe TRA approach for neuroendovascular procedures appears to be safer than the TFA approach. Although a steep learning curve is initially encountered when adopting the TRA approach, the transition to a TRA-first practice can be performed safely for neurointerventional procedures and may reduce complications.

Transradial approach for neurointerventions: a systematic review of the literature

“…The location of the lesion was described as an anterior or posterior circulation lesion in 955 cases, of which 816 (85.44%) were located in the anterior circulation and 121 (14.55%) were located in the posterior circulation. The studies included are described in table 1 7–27…”

“…The site of the arteriotomy in dTRA is distal to the origin of the superficial palmar arch; this is felt to reduce the risk of ischemic symptoms in the case of arterial occlusion at the access site 38. A recent paper comparing TRA (n=117) with dTRA (n=89) performed for both diagnostic and interventional procedures found no significant differences in access site crossovers or complication rates between the two approaches 25…”

“… 38 A recent paper comparing TRA (n=117) with dTRA (n=89) performed for both diagnostic and interventional procedures found no significant differences in access site crossovers or complication rates between the two approaches. 25 …”

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

“…Descriptions of the technique of MMA embolization remain scarce, with the majority of existing literature reporting the injection of microparticles (11,16,17,22,56,57). Some authors have discussed the potential advantages of liquid embolisate for these procedures.…”

Unpredictable times

“…This guidelines document describes the techniques and nuances of transradial access as well as reviews potential complications. The safety and efficacy of the transradial approach has been validated in the pages of the JNIS not only for diagnostic cerebral angiography but for neurointerventions as well 3–6…”