Introduction The transradial approach has been widely adopted for cardiac catheterization due to lower local complication rates and high patient satisfaction. We performed a systematic review and meta-analysis to assess whether the transradial approach is a viable alternative to the transfemoral approach for neuroendovascular procedures.

Methods In February 2018, we searched PubMed/Medline, Embase, Scopus, and the Cochrane databases for studies examining transradial approach to cerebrovascular procedures. Studies focusing on carotid or vertebrobasilar stenting were excluded. Citations were examined by 2 reviewers (RG, CP), and bibliographies of all eligible articles were reviewed for pertinent publications. Data were independently extracted by 2 reviewers (RG, JT), and all data points were compared. Pooled estimates of transradial approach success and technique-related complication rate were assessed with a random-effects model, used due to wide variation in patient selection and procedural technique.

Results Twenty-seven studies with 3260 procedures were included. The pooled procedure success rate was 99% (95% CI: 98.0%–99.0%, I2=77.7%) though in seven studies reporting selective catheterization rates, catheterization of left-sided vessels was significantly less successful than that of right-sided vessels (97.6% (1465/1985) vs 73.8% (2133/2186), X²=494.09, p<0.001). The pooled technique-related complication rate was 0% (95% CI: 0.0%–4.0%, I2=92.55%).

Conclusions The transradial approach to neuroendovascular procedures has a high success rate and low rate of local, approach-specific complications; however, access to left-sided vessels may be limited. This lends support to the idea that the transradial approach can be performed with safety and efficacy.

Acknowledgements Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448, sub-award TL1TR000449, from the National Center for Advancing Translational Sciences (NCATS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Disclosures R. Guniganti: None. J. Thatcher: None. C. Park: None.