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Original research
Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures
  1. Joshua S Catapano1,
  2. Andrew F Ducruet1,
  3. Stefan W Koester1,
  4. Tyler S Cole1,
  5. Jacob F Baranoski1,
  6. Caleb Rutledge1,
  7. Neil Majmundar2,
  8. Visish M Srinivasan1,
  9. D Andrew Wilkinson3,
  10. Michael T Lawton1,
  11. Felipe C Albuquerque1
  1. 1 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  2. 2 Department of Neurosurgery, Rutgers University, Newark, New Jersey, USA
  3. 3 Department of Neurosurgery, Penn State University, Barrow Neurological Institute, Phoenix, Arizona, USA
  1. Correspondence to Dr Felipe C Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix AZ 85013, USA; Felipe.Albuquerque{at}


Background Transradial artery (TRA) access for neuroendovascular procedures is associated with fewer complications than transfemoral artery (TFA) access. This study compares hospital costs associated with TRA access to those associated with TFA access for neurointerventions.

Methods Elective neuroendovascular procedures at a single center were retrospectively analyzed from October 1, 2018 to May 31, 2019. Hospital costs for each procedure were obtained from the hospital financial department. The primary outcome was the difference in the mean hospital costs after propensity adjustment between patients who underwent TRA compared with TFA access.

Results Of the 338 elective procedures included, 63 (19%) were performed through TRA versus 275 (81%) through TFA access. Diagnostic procedures were more common in the TRA cohort (51 of 63, 81%) compared with the TFA cohort (197 of 275, 72%), but the difference was not significant (p=0.48). The TRA cohort had a shorter length of hospital stay (mean (SD) 0.3 (0.5) days) compared with the TFA cohort (mean 0.7 (1.3) days; p=0.02) and lower hospital costs (mean $12 968 ($6518) compared with the TFA cohort (mean $17 150 ($10 946); p=0.004). After propensity adjustment for age, sex, symptoms, angiographic findings, procedure type, sheath size, and catheter size, TRA access was associated with a mean hospital cost of $2514 less than that for TFA access (95% CI −$4931 to −$97; p=0.04).

Conclusion Neuroendovascular procedures performed through TRA access are associated with lower hospital costs than TFA procedures. The lower cost is likely due to a decreased length of hospital stay for TRA.

  • angiography
  • artery
  • brain
  • technique

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  • Contributors All authors made substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work; drafted the work or revised it critically for important intellectual content; provided final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AFD is a consultant for Penumbra, Stryker, Medtronic, Cerenovus, and Koswire, and has ownership interest in Aneuvas, Inc.

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