Transradial versus transfemoral access for posterior circulation endovascular intervention: A systematic review and meta-analysis

• Published in: Clinical neurology and neurosurgery Vol. 234; p. 108006
• Main Authors: Wang, Ying, Zhou, Yi, Cui, Gang, Xiong, Hui, Wang, De-Liang
• Format: Journal Article
• Language: English
• Published: Assen Elsevier Limited 01.11.2023
• Subjects: Bias; Cardiology; Cardiovascular system; Catheters; Clinical outcomes; Fluoroscopy; Intubation; Meta-analysis; Neurology; Patient safety; Retention; Statistical analysis; Success; Systematic review
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2023.108006

ObjectiveTransradial access (TRA) provides a more direct entry to posterior circulation system for endovascular therapy compared to transfemoral access (TFA). This meta-analysis aims to evaluate the safety and feasibility of TRA in neurointervention of posterior circulation.Materials and methodsA systematic search was conducted in the Wanfang Data, CBM, PubMed, Embase, Cochrane Library, Web of Science databases. The primary outcomes included total complications and access site complications. Secondary outcomes were single puncture success, procedural success, access cross-over, catheter retention time and fluoroscopy time.ResultsSix studies encompassing 297 patients were included in the meta-analysis. Compared to the TFA group, the TRA group showed significantly decreased total complications (odds ratio [OR] = 0.29, 95% confidence interval [CI] [0.12, 0.73], p < 0.01) and access site complications (OR = 0.19, 95%CI [0.06, 0.62], p < 0.01), yet it had a longer catheter retention time (mean difference [MD] = 0.80, 95%CI [0.60, 1.00], p < 0.01). There were no significant differences in single puncture success (OR = 3.68, 95%CI[0.38, 35.86], p = 0.26), procedural success (OR = 0.30，95%CI [0.05, 1.73], p = 0.18), access cross-over (OR = 2.29, 95%CI [0.19, 28.26], p = 0.52), fluoroscopy time (MD = 0.97, 95%CI [- 0.91, 2.84], p = 0.31) between the TRA and TFA groups.ConclusionThis meta-analysis demonstrated that TRA is a safe and feasible alternative to TFA for neurointervention in the posterior circulation. TRA showed significantly decreased total complications and access site complications, yet it had a longer catheter retention time than TFA.