Propensity-Adjusted Comparative Analysis of Radial Versus Femoral Access for Neurointerventional Treatments

Authors

Joshua S. Catapano, Barrow Neurological InstituteFollow
Andrew F. Ducruet, Barrow Neurological InstituteFollow
Candice L. Nguyen, Barrow Neurological InstituteFollow
Neil Majmundar, Barrow Neurological Institute
D. Andrew Wilkinson, Barrow Neurological Institute
Tyler S. Cole, Barrow Neurological InstituteFollow
Jacob F. Baranoski, Barrow Neurological InstituteFollow
Daniel D. Cavalcanti, Barrow Neurological InstituteFollow
Vance L. Fredrickson, Barrow Neurological Institute
Visish M. Srinivasan, Barrow Neurological InstituteFollow
Caleb Rutledge, Barrow Neurological InstituteFollow
Michael T. Lawton, Barrow Neurological InstituteFollow
Felipe C. Albuquerque, Barrow Neurological InstituteFollow

Document Type

Article

Abstract

BACKGROUND: Transradial artery (TRA) catheterization for neuroendovascular procedures is associated with a lower risk of complications than transfemoral artery (TFA) procedures. However, the majority of literature on TRA access pertains to diagnostic procedures rather than interventional treatments. OBJECTIVE: To compare TRA and TFA approaches for cerebrovascular interventions. METHODS: All patients with an endovascular intervention performed at a single center from October 1, 2018 to December 31, 2019 were retrospectively analyzed. Patients were grouped into 2 cohorts on the basis of whether TRA or TFA access was used. Outcomes included complications, fluoroscopy times, and total contrast administered. RESULTS: A total 579 interventional treatments were performed during the 15-mo study period. TFA procedures (n = 417) were associated with a significantly higher complication rate than TRA (n = 162) procedures (43 cases [10%] vs 5 cases [3%]; P = .008). After excluding patients who underwent thrombectomy and performing a propensity adjustment (including age, sex, pathology, procedure, sheath size, and catheter size), TRA catheterization was associated with decreased odds of a complication (odds ratio, 0.25; 95% CI 0.085-0.72; P = .01), but no significant difference in the amount of contrast administered (6.7-mL increase; 95% CI, -7.2 to 20.6; P = .34) or duration of fluoroscopy (2.1-min increase; 95% CI, -2.5 to 6.7; P = .37) compared with TFA catheterization. CONCLUSION: Neurointerventional procedures and treatments for a variety of pathologies can be performed successfully using the TRA approach, which is associated with a lower risk of complications and no difference in fluoroscopy duration compared with the TFA approach.

Publication Date

5-13-2021

Publication Title

Neurosurgery

E-ISSN

15244040

Volume

88

Issue

6

First Page

E505

Last Page

E509

PubMed ID

33582816

Digital Object Identifier (DOI)

10.1093/neuros/nyab036

Recommended Citation

Catapano, Joshua S.; Ducruet, Andrew F.; Nguyen, Candice L.; Majmundar, Neil; Wilkinson, D. Andrew; Cole, Tyler S.; Baranoski, Jacob F.; Cavalcanti, Daniel D.; Fredrickson, Vance L.; Srinivasan, Visish M.; Rutledge, Caleb; Lawton, Michael T.; and Albuquerque, Felipe C., "Propensity-Adjusted Comparative Analysis of Radial Versus Femoral Access for Neurointerventional Treatments" (2021). Neurosurgery. 1414.
https://scholar.barrowneuro.org/neurosurgery/1414