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Lower complication rates associated with transradial versus transfemoral flow diverting stent placement
  1. Yangchun Li1,
  2. Stephanie H Chen2,
  3. Alejandro M Spiotta3,
  4. Pascal Jabbour4,
  5. Michael R Levitt5,
  6. Peter Kan6,
  7. Christoph J Griessenauer7,8,
  8. Adam S Arthur9,10,
  9. Joshua W Osbun11,
  10. Min S Park12,
  11. Nohra Chalouhi4,
  12. Ahmad Sweid4,
  13. Stacey Q Wolfe13,
  14. Kyle M Fargen14,
  15. Aaron S Dumont15,
  16. Travis M Dumont16,
  17. Marie-Christine Brunet2,
  18. Samir Sur1,
  19. Evan Luther2,
  20. Allison Strickland2,
  21. Dileep R Yavagal17,
  22. Eric C Peterson18,
  23. Clemens M Schirmer7,19,
  24. Oded Goren20,
  25. Shamsher Dalal7,
  26. Gregory Weiner21,
  27. Axel Rosengart7,
  28. Daniel Raper22,
  29. Ching-Jen Chen23,
  30. Peter Amenta24,
  31. Tyler Scullen25,
  32. Cory Michael Kelly26,
  33. Christopher Young26,
  34. Michael Nahhas27,
  35. Eyad Almallouhi27,
  36. Arunprasad Gunasekaran3,
  37. Suhas Pai3,
  38. Giuseppe Lanzino28,
  39. Waleed Brinjikji29,
  40. Mehdi Abbasi28,
  41. David Dornbos III30,31,
  42. Nitin Goyal32,
  43. Jeremy Peterson10,33,
  44. Mohammad H El-Ghanem34,
  45. Robert M Starke1,35
  1. 1 Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2 Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  3. 3 Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4 Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
  5. 5 Neurological Surgery, Radiology and Mechanical Engineering and Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
  6. 6 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  7. 7 Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
  8. 8 Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
  9. 9 Department of Neurological Surgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  10. 10 Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  11. 11 Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  12. 12 Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
  13. 13 Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
  14. 14 Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
  15. 15 Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA
  16. 16 Neurosurgery, Neurology and Medical Imaging, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
  17. 17 Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
  18. 18 Neurological Surgery, University of Miami, Miami, Florida, USA
  19. 19 Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
  20. 20 Neurosurgery, Geisinger, Danville, Pennsylvania, USA
  21. 21 Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA
  22. 22 Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
  23. 23 Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
  24. 24 Neurological Surgery, Tulane Medical Center Downtown, New Orleans, Louisiana, USA
  25. 25 Neurosurggery, Tulane University, New Orleans, Louisiana, USA
  26. 26 Neurological Surgery, University of Washington, Seattle, Washington, USA
  27. 27 Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  28. 28 Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  29. 29 Neurosurgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  30. 30 Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
  31. 31 Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
  32. 32 Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  33. 33 Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  34. 34 Neurosurgery, Neurology and Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona, USA
  35. 35 Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Robert M Starke, Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; RStarke{at}med.miami.edu

Abstract

Background Currently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion.

Methods We retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches.

Results A total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035).

Conclusion TRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series.

  • aneurysm
  • intervention
  • flow diverter
  • complication
  • artery

https://doi.org/10.1136/neurintsurg-2020-015992

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    Footnotes

    • Twitter @PascalJabbourMD, @AdamArthurMD, @MichaelNahhas, @DornbosIII_MD, @Starke_neurosurgery

    • YL and SHC contributed equally.

    • Contributors Conception: RMS. Data acquisition: all authors. Statistical analysis: YL and RMS. Drafting and critical revisions: all authors. Final approval and agreement to accountability: all authors.

    • Funding This research is in part supported by National Institutes of Health (R01NS111119-01A1) and (UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute.

    • Competing interests RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and by National Institute of Health (R01NS111119-01A1) and (UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. RMS has consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo and Cerenovus. DRY: Medtronic Neurovascular: Consultant, Cerenovus: Consultant, Rapid Medical and Neuralanalytics: consultant. ECP: Stryker Neurovascular: Consultant, Penumbra: Consultant, RIST Neurovascular: Stockholder, Medtronic Neurovascular: Consultant, Cerenovus: Consultant. MRL: Grants: National Institutes of Health (R01NS105692, R01NS088072, U24NS100654); American Heart Association (18CDA34110295); The Aneurysm and AVM Foundation. Unrestricted educational grants: Stryker Neurovascular, Medtronic, Philips Volcano. Equity interest: eLoupes Inc, Cerebrotech, Synchron. AS: Penumbra: consulting, research support, Stryker: consulting, Cerenovus: consulting. CMS: NTI stockholder, AANS honoraria. ASA: Consultant for Johnson and Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, Stryker. Research support from Balt, Cerenovus, Medtronic, Microvention, Penumbra, Siemens, and Stryker. Shareholder in Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad Medical, Vascular Simulations. JWO: Disclosures: consultant for Terumo, Medtronic, Microvention. Royalties: Caeli Vascular, inc.

    • Patient consent for publication Not required.

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

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.