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Original research
Complications of transradial versus transfemoral access for neuroendovascular procedures: a meta-analysis
  1. Derrek Schartz1,
  2. Sajal Medha K Akkipeddi2,
  3. Nathaniel Ellens2,
  4. Redi Rahmani2,
  5. Gurkirat Singh Kohli2,
  6. Jeffrey Bruckel3,
  7. Justin M Caplan4,
  8. Thomas K Mattingly2,
  9. Tarun Bhalla2,
  10. Matthew T Bender2
  1. 1Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
  2. 2Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
  3. 3Cardiology, University of Rochester Medical Center, Rochester, New York, USA
  4. 4Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Matthew T Bender, Neurosurgery, University of Rochester Medical Center, Rochester, NY 14642, USA; matthew_bender{at}urmc.rochester.edu

Abstract

Background Transradial access (TRA) has gained increased usage among neurointerventionalists. However, the overall safety profile of access site complications (ASCs) and non-access site complications (NASCs) of TRA versus transfemoral access (TFA) for neuroendovascular procedures remains unclear.

Methods A systematic literature review and meta-analysis using a random effects model was conducted to investigate the pooled odds ratios (OR) of ASCs and NASCs. Randomized, case–control, and cohort studies comparing access-related complications were analyzed. An assessment of study heterogeneity and publication bias was also completed.

Results Seventeen comparative studies met the inclusion criteria for final analysis. Overall, there was a composite ASC rate of 1.8% (49/2767) versus 3.2% (168/5222) for TRA and TFA, respectively (P<0.001). TRA was associated with a lower odds of ASC compared with TFA (OR 0.42; 95% CI 0.25 to 0.68, P<0.001, I2=31%). There was significantly lower odds of complications within the intervention and diagnostic subgroups. For NASC, TRA had a lower composite incidence of complications than TFA at 1.2% (31/2586) versus 4.2% (207/4909), P<0.001). However, on meta-analysis, we found no significant difference overall between TRA and TFA for NASCs (OR 0.79; 95% CI 0.51 to 1.22, P=0.28, I2=0%), which was also the case on subgroup analysis.

Conclusion On meta-analysis, the current literature indicates that TRA is associated with a lower incidence of ASCs compared with TFA, but is not associated with a lower rate of NASCs.

  • stroke
  • angiography
  • intervention
  • technique
  • aneurysm

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors The authors made the following contributions to this manuscript: DS: research conception, data collection, data analysis, data interpretation, manuscript writing, manuscript editing, manuscript appraisal. Guarantor. SMKA: data collection, manuscript editing, manuscript appraisal. NE: data interpretation, manuscript editing, manuscript appraisal. RR: data interpretation, manuscript editing, manuscript appraisal. GSK: data interpretation, manuscript editing, manuscript appraisal. JB: data interpretation, manuscript writing, manuscript editing, manuscript appraisal. JMC: data interpretation, manuscript editing, manuscript appraisal. TM: data interpretation, manuscript writing, manuscript editing, manuscript appraisal. TB: data interpretation, manuscript editing, manuscript appraisal. MTB: research conception, data interpretation, manuscript writing, manuscript editing, manuscript appraisal. Guarantor.

  • 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 JB: Consulting relationships with Asahi Intecc and AvantGarde Health for work on coronary guidewires.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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