Systematic Review of Transradial Access for Flow Diversion of Intracranial Aneurysms

Distal radial access for neuroangiography and neurointerventions: systematic review and meta-analysis

BACKGROUND

Many studies have shown that coronary angiography (CAG) and percutaneous coronary intervention (PCI) via distal radial access (DRA) are safe and effective. Safety and efficacy of neuroangiography and neurointerventions via DRA are unknown.

PURPOSE

Search the literatures on neuroangiography and neurointerventions via DRA and conduct a systematic review and meta-analysis.

METHODS

PubMed, Embase and Cochrane were searched from inception to November 10, 2022. After literature screening, data extraction and assessment of literature quality, random effects model was used for meta-analysis.

RESULTS

A total of 236 literatures were retrieved, and 17 literatures including 1163 patients were finally included for meta-analysis.The pooled access success rate was 0.96 (95% confidence interval, 0.94-0.98), and the heterogeneity was obvious (I2 = 55.5%). The pooled access-related complications incidence rate was 0.03 (95% confidence interval, 0.02-0.05), and the heterogeneity was not obvious (I2 = 15.8%).

CONCLUSION

Neuroangiography and neurointerventions via DRA may be safe and effective. DRA is an alternative access for neuroangiography and neurointerventions.

Therapeutic Neurointervention through Transradial Approach: Preliminary Experience from a Tertiary Care Center

Aim The aim of this study was to assess the safety and feasibility of radial access for therapeutic neurointervention procedures.

Methods The retrospective evaluation of 20 patients taken for therapeutic neurointervention through transradial access at our institute was done from July 2021 to April 2022.

Results Therapeutic neurointervention procedures were attempted in 20 patients (age, 24–74 years; mean age, 48.4 years; 13 (65%) females using a transradial approach. The radial artery's mean diameter was 2.135 mm. The right radial access was taken in 18 (90%) cases. Indications for treatment were ruptured aneurysm in 13 (65%), mechanical thrombectomy in 5 (25%), flow diversion for a recanalized aneurysm in 1 (5%), and balloon occlusion test in 1 (5%) case. The procedure was successful through the transradial approach in 18 (90%) procedures. Failure was seen in two cases that were completed after conversion to the transfemoral approach. The reason for access conversion was a severe spasm in both cases. No significant access site complications were seen in the study cohort.

Conclusion A radial access route is a promising approach for therapeutic interventions with a high success rate and minimal access site complications. Interventionists should get accustomed to this approach as primary or alternative access for neurointervention.

Transradial versus transfemoral access for endovascular therapy of intracranial aneurysms: a systematic review and meta-analysis of cohort studies

Endovascular treatment is widely used in the treatment of intracranial aneurysms. However, neurosurgeons are sceptical about endovascular access via the radial artery. We performed a systematic review and meta-analysis to compare the effectiveness and safety of transradial and transfemoral artery access in patients with intracranial aneurysms. We systematically searched the PubMed, Embase, and Cochrane databases for studies comparing the two approaches. The primary outcome was total complications, and the secondary outcomes were access site complications, intracranial haemorrhage, stroke, thromboembolism, silent infarct, re-treatment rate, mortality, complete occlusion of intracranial aneurysms, procedure duration, and length of hospital stay. A random-effects model was used to assess the pooled data. Of the 100 identified studies, 6 were eligible (a total of 3764 participants). There were no significant differences in total complications(odds ratio [OR] = 0.69, 95% confidence interval [CI] [0.33, 1.45], p = 0.32), complete occlusion of intracranial aneurysms (OR = 1.02, 95%CI [0.77,1.37], p = 0.87), procedure duration (mean difference [MD] =  - 6.24, 95%CI [- 14.75, - 1.54], p = 0.95), or length of hospital stay (MD = 2.204, 95%CI [- 0.05, 4.45], p = 0.95), access site complications (OR = 0.49, 95%CI [0.16, 1.52], p = 0.22), intracranial haemorrhage (OR = 1.07, 95%CI [0.49, 2.34], p = 0.86), stroke (OR = 0.59, 95%CI [0.20, 1.77], p = 0.35), thromboembolism (OR = 0.85, 95%CI [0.33, 2.17], p = 0.74), silent infarct (OR = 0.69, 95%CI [0.04, 11.80], p = 0.80), retreatment rate (OR = 1.32, 95%CI [0.70, 2.48], p = 0.39), mortality (OR = 1.41, 95%CI [0.06, 5.20], p = 0.61), immediate occlusion (OR = 0.99, 95%CI [0.64, 1.51], p = 0.95), and occlusion during follow-up (OR = 1.10, 95%CI [0.56, 2.16], p = 0.74) between the transradial and transfemoral groups. This study showed comparable safety and efficacy outcomes between transradial and transfemoral access in patients with intracranial aneurysms treated endovascularly. Future large randomised trials are warranted to confirm these findings.