Avoiding the Radial Paradox: Neuroendovascular Femoral Access Outcomes After Radial Access Adoption
Document Type
Article
Abstract
BACKGROUND: Transradial access (TRA) for neuroendovascular procedures is increasing in prevalence. The safety benefits of TRA at a patient level may be offset at a population level by a paradoxical increase in transfemoral access (TFA) vascular access site complications (VASCs), the so-called "radial paradox." OBJECTIVE: To study the effect of TRA adoption on TFA performance and outcomes in neuroendovascular procedures. METHODS: Data were collected for all procedures performed over a 10-mo period after radial adoption at a single center. RESULTS: Over the study period, 1084 procedures were performed, including 719 (66.3%) with an intent to treat by TRA and 365 (33.7%) with an intent to treat by TFA. Thirty-two cases (4.4%) crossed over from TRA to TFA, and 2 cases (0.5%) crossed over from TFA to TRA. TFA was performed in older patients (mean [standard deviation] TFA, 63 [15] vs TRA, 56 [16] years) using larger sheath sizes (≥7 French; TFA, 56.2% vs TRA, 2.3%) ( P < .001 for both comparisons). Overall, 29 VASCs occurred (2.7%), including 27 minor (TFA, 4.6% [18/395] vs TRA, 1.3% [9/689], P = .002) and 2 major (TFA, 0.3% [1/395] vs TRA, 0.1% [1/689], P > .99) complications. Independent predictors of VASC included TFA (OR 2.8, 95% confidence interval [CI] 1.1-7.4) and use of dual antiplatelet therapy (OR 4.2, 95% CI 1.6-11.1). CONCLUSION: TFA remains an important access route, despite a predominantly radial paradigm, and is disproportionately used in patients at increased risk for VASCs. TFA proficiency may still be achieved in predominantly radial practices without an increase in femoral complications.
Medical Subject Headings
Aged; Catheterization, Peripheral (adverse effects, methods); Cross-Over Studies; Femoral Artery (surgery); Humans; Lower Extremity; Radial Artery (surgery); Treatment Outcome
Publication Date
3-1-2022
Publication Title
Neurosurgery
E-ISSN
1524-4040
Volume
90
Issue
3
First Page
287
Last Page
292
PubMed ID
34995246
Digital Object Identifier (DOI)
10.1227/NEU.0000000000001787
Recommended Citation
Wilkinson, D Andrew; Majmundar, Neil; Catapano, Joshua S.; Cole, Tyler S.; Baranoski, Jacob F.; Hendricks, Benjamin K.; Cavalcanti, Daniel D.; Frederickson, Vance L.; Ducruet, Andrew F.; and Albuquerque, Felipe C., "Avoiding the Radial Paradox: Neuroendovascular Femoral Access Outcomes After Radial Access Adoption" (2022). Translational Neuroscience. 2238.
https://scholar.barrowneuro.org/neurobiology/2238