Complications of transradial versus transfemoral access for neuroendovascular procedures: a meta-analysis

Derrek Schartz, Sajal Medha K. Akkipeddi, Nathaniel Ellens, Redi Rahmani, Gurkirat Singh Kohli, Jeffrey Bruckel, Justin M. Caplan, Thomas K. Mattingly, Tarun Bhalla, Matthew T. Bender

Research output: Contribution to journalArticlepeer-review

Abstract

Background Transradial access (TRA) has gained increased usage among neurointerventionalists. However, the overall safety profile of access site complications (ASCs) and non-access site complications (NASCs) of TRA versus transfemoral access (TFA) for neuroendovascular procedures remains unclear. Methods A systematic literature review and meta-analysis using a random effects model was conducted to investigate the pooled odds ratios (OR) of ASCs and NASCs. Randomized, case–control, and cohort studies comparing access-related complications were analyzed. An assessment of study heterogeneity and publication bias was also completed. Results Seventeen comparative studies met the inclusion criteria for final analysis. Overall, there was a composite ASC rate of 1.8% (49/2767) versus 3.2% (168/5222) for TRA and TFA, respectively (P<0.001). TRA was associated with a lower odds of ASC compared with TFA (OR 0.42; 95% CI 0.25 to 0.68, P<0.001, I2=31%). There was significantly lower odds of complications within the intervention and diagnostic subgroups. For NASC, TRA had a lower composite incidence of complications than TFA at 1.2% (31/2586) versus 4.2% (207/4909), P<0.001). However, on meta-analysis, we found no significant difference overall between TRA and TFA for NASCs (OR 0.79; 95% CI 0.51 to 1.22, P=0.28, I2=0%), which was also the case on subgroup analysis. Conclusion On meta-analysis, the current literature indicates that TRA is associated with a lower incidence of ASCs compared with TFA, but is not associated with a lower rate of NASCs.

Original languageEnglish (US)
Pages (from-to)820-825
Number of pages6
JournalJournal of neurointerventional surgery
Volume14
Issue number8
DOIs
StatePublished - Aug 2022

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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