Abstract
INTRODUCTION Observational studies have demonstrated the safety and feasibility of the transradial approach for neurointerventional procedures. However, there are no large-scale studies in the neurointerventional literature which have compared safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. METHODS We retrospectively analyzed flow diversion cases for treatment of cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall procedure-related complication rate were compared between the two approaches. RESULTS A total of 2,311 patients who underwent endovascular flow diversion were analyzed with 134 (5.86%) treated with TRA and 2,151 (94.14%) via TFA. The two groups shared similar demographic composition, comorbidities, clinical presentation, and aneurysm characteristics. Cross-over from TRA to TFA was documented in 12 (8.63%) patients due to radial artery spasm, vessel tortuosity, or inadequate support. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort compared to TRA (2.48% 95% CI 2.40-2.57 vs. 0%, P = .039). Of the 53 access site complications, 6 patients (0.28%) required blood transfusion. One death resulted from a femoral access site complication. Overall complications rate was also higher in the TFA group (9.02%; 95% CI 8.15-9.89) compared with the TRA group (3.73%; 95% CI 3.13-4.28; P = .035). CONCLUSION TRA is a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower with TRA compared with TFA. The results of this study support the transition to a radial-first approach for endovascular flow diversion.