RT Journal Article
SR Electronic
T1 Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 611
OP 615
DO 10.1136/neurintsurg-2019-015569
VO 12
IS 6
A1 Catapano, Joshua S
A1 Fredrickson, Vance L
A1 Fujii, Tatsuhiro
A1 Cole, Tyler S
A1 Koester, Stefan W
A1 Baranoski, Jacob F
A1 Cavalcanti, Daniel D
A1 Wilkinson, D Andrew
A1 Majmundar, Neil
A1 Lang, Michael J
A1 Lawton, Michael T
A1 Ducruet, Andrew F
A1 Albuquerque, Felipe C
YR 2020
UL http://jnis.bmj.com/content/12/6/611.abstract
AB 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.