The association of transradial access and transfemoral access with procedural outcomes in acute ischemic stroke patients receiving endovascular thrombectomy: A meta-analysis

Shirin Shaban; Aarushi Rastogi; Subash Phuyal; Bella Huasen; Abilash Haridas; Kamil Zelenak; Marta Iacobucci; Mario Martínez-Galdámez; Pascal Jabbour; Sonu Menachem Maimonides Bhaskar

doi:10.1016/j.clineuro.2022.107209

The association of transradial access and transfemoral access with procedural outcomes in acute ischemic stroke patients receiving endovascular thrombectomy: A meta-analysis

Clin Neurol Neurosurg. 2022 Apr:215:107209. doi: 10.1016/j.clineuro.2022.107209. Epub 2022 Mar 11.

Affiliations

¹ Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; University of New South Wales (UNSW), South-Western Sydney Clinical School, NSW, Australia.
² Division of Neurointerventional Surgery, Neuroimaging, and Interventional Radiology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Kathmandu, Nepal.
³ Department of Interventional Radiology, Lancashire University Teaching Hospitals, Lancashire Care NHS Foundation Trust, Preston, United Kingdom.
⁴ St Joseph's Hospital, Baycare Medical Group, Pediatric Neurosurgery, Cerebrovascular and Skull Base Neurosurgery, Tampa, FL, USA.
⁵ Department of Interventional Radiology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia.
⁶ Department of Human Neurosciences, Interventional Neuroradiology Unit, University Hospital "Umberto I", Rome, Italy.
⁷ Division of Interventional Neuroradiology, Junta de Castilla y Leon University Clinic Hospital and Service of Diagnostic Imaging, Hospital La Luz, Quiron Salud, Madrid, Spain.
⁸ Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
⁹ Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; NSW Brain Clot Bank, NSW Health Pathology, Sydney, Australia; Department of Neurology and Neurophysiology, Comprehensive Stroke Center, Liverpool Hospital and South-Western Sydney Local Health District, Sydney, Australia. Electronic address: smmb@globalhealthneurolab.org.

PMID: 35290788
DOI: 10.1016/j.clineuro.2022.107209

Abstract

Objective: There is an ongoing debate regarding the benefits of using transradial access (TRA) over transfemoral access (TFA) in endovascular therapies including endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) patients. This study sought to investigate the association of TRA and TFA with procedural success, access-site complications, first-pass reperfusion (FPR), puncture-to-recanalisation (PTR) time and hemorrhagic transformation (HT) by performing a meta-analysis.

Materials and methods: PubMed, EMBASE and Scopus were searched. Studies with patients aged ≥ 18 years and head-to-head TRA vs TFA comparisons were included. Random-effects modeling was performed to obtain summary effects and forest plots were plotted to study the association of TFA with access site complications, FPR, HT, PTR time and procedural success.

Results: Six studies encompassing 945 patients (347 TRA and 598 TFA) were included in the meta-analysis. Meta-analysis revealed that in AIS patients receiving EVT, TRA was significantly associated with a decreased risk of access-site complications (RR 0.17, 95% CI 0.05 0.54; p = 0.003, z = -2.957) and HT (RR 0.07, 95% CI 0.02 0.27; p < 0.0001, z = -3.8841). However, TRA was not significantly associated with procedural success (RR 0.96, 95% CI 0.90 1.01; p = 0.141, z = -1.473), FPR (RR 0.91, 95% CI 0.79 1.05; p = 0.194, z = -1.299) and PTR time (SMD -0.14, 95% CI -0.42 -0.14; p = 0.323, z = -0.989).

Conclusion: Our meta-analysis demonstrated that TRA is a safe alternative to TFA, in AIS patients receiving EVT, with significantly decreased access-site complications and HT with TRA, albeit with comparable procedural success, FPR and PTR time to TFA.

Data availability statement: The original contributions presented in the study are included in the article/Supplementary information, further inquiries can be directed to the corresponding author.

Keywords: Cardiovascular; Cerebrovascular disease; Endovascular therapy; Reperfusion; Stroke; Thrombectomy; Transfemoral; Transradial.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Catheterization, Peripheral* / adverse effects
Femoral Artery / surgery
Hemorrhage / etiology
Humans
Ischemic Stroke* / surgery
Radial Artery / surgery
Retrospective Studies
Thrombectomy / adverse effects
Treatment Outcome