Random effects meta-analysis of the primary and secondary outcomes, heterogeneity testing, and bias risk assessment
| Outcome study | Patients | Procedural success | Crossover | Radial/SCA* failure | CCA cannulation failure† | ARAO | FAH | Access site major complications | Minor CVA (d≤30) | Major CVA (d≤30) | Deaths |
| Gao et al, 201815 | 28 | 28 (100.0%) | 0 (0%) | 0 | 0 | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
| Mendiz et al, 201614 | 101 | 96 (95.0%) | 5 (5.0%) | 0/5 | 5/5 R 4 L 1: 1 NB | NR | 1 (1.0%) | 0 (0%) | 1 (1.0%) | 2 (2.0%) | 0 (0%) |
| Ruzsa et al, 20142 | 130 | 117 (90.0%) | 13 (10.0%) | 7/13 | 6/13 R 2 L 4: 4 NB | 8 (6.2%) | 2 (1.5%) | 2 (1.5%) | 0 (0%) | 1 (0.8%) | 2 (1.5%) |
| Etxegoien et al, 201211 | 382 | 347 (90.8%) | 35 (9.2%) | 0/35 | 35/35 R 15 L 20: 18 NB | 23 (6.0%) | NR | 0 (0%) | 13 (3.4%) | 2 (0.5%) | 1 (0.3%) |
| Patel et al, 201012 | 20 | 16 (80.0%) | 4 (20.0%) | 0/4 | 4/4 R 0 L 4: NR | NR | 0 (0%) | 0 (0%) | 1 (5.0%) | 0 (0%) | 0 (0%) |
| Pinter et al, 200713 | 20 | 18 (90.0%) | 2 (10.0%) | 1/2 | 1/2 R 0 L 1: 1 NB | 1 (5.0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
| Folmar et al, 200710 | 42 | 35 (83.3%) | 7 (16.7%) | 0/7 | 7/7 R 1 L 6: 5 NB | NR | 0 (0%) | 0 (0%) | 1 (2.4%) | 0 (0%) | 0 (0%) |
| Total | 723 | 657 | 66 | 8/66 | 58/66 R 22 L 36 NB 29/32 | 32/560 | 3/341 | 2 | 16 | 5 | 3 |
| Meta-analysis: Random effects (DerSimonian and Laird) | |||||||||||
| Proportion (95% CI) | 90.8% (86.7% to 94.2%) | 9.2% (5.8% to 13.3%) | 5.9% (4.1% to 8.0%) | 1.4% (0.4% to 2.9%) | 0.4% (0.1% to 0.9%) | 1.9% (0.6% to 3.8%) | 1.0% (0.4% to 1.8%) | 0.6% (0.2% to 1.3%) | |||
| Heterogeneity testing | |||||||||||
| Cochran Q (p value) | 12.799 (0.046) | 12.799 (0.046) | 2.783 (0.426) | 0.580 (0.989) | 5.609 (0.468) | 10.39 (0.109) | 1.990 (0.921) | 2.800 (0.834) | |||
| I2 | 53.1% | 53.1% | 0% | 0% | 0% | 42.3% | 0% | 0% | |||
| Statistically significant | Yes | Yes | No | No | No | No | No | No | |||
| Bias risk assessment | |||||||||||
| Egger (p value) | −0.575 (0.639) | 0.575 (0.639) | −0.996 (0.478) | −0.560 (0.071) | 0.192 (0.439) | 0.390 (0.652) | 0.024 (0.954) | 0.058 (0.851) | |||
| Harbord (p value) | −0.435 (0.709) | 0.435 (0.709) | −0.917 (0.300) | −1.046 (0.013) | 0.046 (0.962) | −0.877 (0.363) | −0.225 (0.686) | −0.218 (0.740) | |||
| Statistically significant | No | No | No | No | No | No | No | No | |||
ARAO, asymptomatic radial artery occlusion; CCA, common carotid artery; CVA, cerebrovascular accident; d≤30, occurring within 30 days after the procedure; FAH, forearm hematoma; L, left; NB, non-bovine; R, right; SCA, subclavian artery.
↵*Radial/SCA failure: procedural failure due to failed radial artery access, radial artery spasm, radial artery loop, or subclavian artery stenosis.
†CCA cannulation failure: procedural failure due to inability to cannulate the affected common carotid artery with the guide catheter/sheath.