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Original research
Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment
  1. Joshua S Catapano1,
  2. Vance L Fredrickson1,
  3. Tatsuhiro Fujii2,
  4. Tyler S Cole1,
  5. Stefan W Koester1,
  6. Jacob F Baranoski1,
  7. Daniel D Cavalcanti1,
  8. D Andrew Wilkinson1,
  9. Neil Majmundar1,
  10. Michael J Lang1,
  11. Michael T Lawton1,
  12. Andrew F Ducruet1,
  13. Felipe C Albuquerque1
  1. 1 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  2. 2 Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Califronia, USA
  1. Correspondence to Dr Felipe C Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA; neuropub{at}


Background The 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.

Methods A 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.

Results A 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).

Conclusion The 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.

  • complications
  • TRA
  • transradial neuroendovascular
  • TRF
  • transfemoral neuroendovascular

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  • Contributors All authors made substantial contributions to the conception or design of the work. JSC: study design, data collection, data analysis, manuscript editing and writing, and statistical analysis. ML: study design and data analysis. SK: data collection and manuscript writing. NM: study design and analysis. DAW: study design and analysis. JFB: manuscript editing and data analysis. VLF: manuscript editing and data analysis. TSC: manuscript editing, data analysis, statistical anaylsis. TF: manuscript writing. DDC: data collection. MTL: study design and manuscript editing. AFD: study design and manuscript editing. FCA: study design, manuscript editing, and guarantor.

  • Disclaimer The institutional review board waived the need for patient consent because of the retrospective nature of the study. Thus, no attempt was made to contact patients whose data were included in the analysis. Personal data have been sufficiently anonymized per the journal requirements.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.