Lower Complication Rates Associated with Transradial vs. Transfemoral Flow Diverting Stent Placement. (16th November 2020)

• Record Type: Journal Article
• Authors: Li, Yangchun; Chen, Stephanie H; Spiotta, Alejandro M; Jabbour, Pascal; Levitt, Michael R; Kan, Peter; Griessenauer, Christoph J; Arthur, Adam S; Osbun, Joshua W; Park, Min S; Chalouhi, Nohra El; Sweid, Ahmad; Wolfe, Stacey Q; Fargen, Kyle M; Dumont, Aaron S; Dumont, Travis M; Brunet, Marie-Christine; Sur, Samir; Luther, Evan; Strickland, Allison; Yavagal, Dileep R; Peterson, Eric C; Schirmer, Clemens M; Goren, Oded; Dalal, Shamsher; Weiner, Gregory; Rosengart, Axel; Raper, Daniel; Chen, Ching-Jen; Amenta, Peter S; Scullen, Tyler; Kelly, Cory; Young, Christopher C; Nahhas, Michael; Almallouhi, Eyad; Gunasekaran, Arunprasad; Pai, Suhas; Lanzino, Giuseppe; Brinjikji, Waleed; Abbasi, Mehdi; Dornbos, David; Goyal, Nitin; Peterson, Jeremy C; El-Ghanem, Mohammad; Starke, Robert M;
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_237
• Languages: English
• ISSNs: 0148-396X

Abstract

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.