Objective The popularity of trans-radial access (TRA) for cerebral angiography is growing. Potential benefits of TRA over traditional trans-femoral access (TFA) include a lower rate of vascular access site complications, earlier post-procedure patient ambulation and shorter recovery time. This study aimed to evaluate discharge outcomes and patient opinion of TRA compared to TFA in patients undergoing cerebral angiography prior to stereotactic radiosurgery (SRS; Gamma Knife) treatment for cerebral arteriovenous malformations (AVMs).
Methods Consecutive patients treated at the National Centre for Stereotactic Radiosurgery (Sheffield, UK) over a 22-month period were included. All patients underwent cerebral angiography with either TRA or TFA as part of treatment planning prior to SRS. Demographic, procedural and discharge information were collected for each patient, with comparison between the TRA and TFA groups. A subset of TRA patients who had previously undergone TFA in other centres were surveyed for their experience of cerebral angiography using a questionnaire. SRS staff at our centre were approached for their opinion on the use of TRA.
Results 492 patients were included (median age = 43 years, 57.5% male, median number of lesions treated = 1). More patients underwent angiography with TFA (75.2%) than TRA (24.8%). No difference was found in accumulated dose for angiography between the groups (p<0.05). There was 17.6% reduction in overnight stay between TRA and TRF. proportion of patients requiring overnight admission was higher for the TFA (35.2%) than TRA (17.6%, p<0.05). 101 patients were surveyed, with a response rate of 47%. Most respondents (79%) indicated preference for TRA over TFA. Respondents frequently commented on better post-procedure mobility with TRA (45%). Staff opinion of TRA was positive, with better efficiency of care and lower concern for access site complications.
Conclusions Use of TRA in pre-SRS cerebral angiography is feasible and improves both patient and staff experience. The adoption of TRA as a first-line vascular access method in this patient population could have important implications for department resources and costs by reducing the proportion of overnight admissions.
Disclosures S. Kular: None. G. Tse: None.
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