Details

Autor(en) / Beteiligte

• Wilkinson, D. Andrew
• Majmundar, Neil J
• Catapano, Joshua
• Cole, Tyler S
• Baranoski, Jacob F
• Hendricks, Benjamin K
• Ducruet, Andrew F
• Albuquerque, Felipe

Titel

Maintaining Femoral Proficiency in a Radial-First Neuroendovascular Training Program

Ist Teil von

• Neurosurgery, 2020-12, Vol.67 (Supplement_1)

Ort / Verlag

Philadelphia: Wolters Kluwer Health, Inc

Erscheinungsjahr

2020

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• INTRODUCTION Transradial arterial access (TRA) for neuroendovascular procedures is increasing in prevalence, with some labs converting to a "radial-first" approach. However, a number of procedures are still performed using transfemoral access (TFA), including many cases at high risk for complications. Some have suggested the safety benefit of TRA may be offset by a paradoxical increase in TFA complications associated with radial adoption. METHODS Data was collected prospectively for all neuroendovascular procedures performed over a ten-month period by trainees under a "radial-first" paradigm. Demographics, procedural characteristics, access-specific details, and major and minor access-site complications were collected. RESULTS Over the study period, 1,084 procedures were performed in 884 unique patients, including 689 undergoing TRA and 395 undergoing TFA. Thirty-two patients crossed over from TRA to TFA, and two patients crossed over from TFA to TRA. In comparison to TRA, patients undergoing TFA were older (63 ± 15 vs. 56 ± 16), predominantly male (52.9% vs. 38.6%), had larger sheath sizes (greater than 6 French 69.6% vs. 36.5%), and had higher rates of emergent performance (42.0% vs. 0.7%) and tPA administration (15.0% vs. 0%), but lower rates of systemic anticoagulation (35.4% vs. 75.4%) (all P < .001). There were 29 access site complications overall (2.7%), including 27 minor (TFA 4.6% vs. TRA 1.3%, P = .002) and 2 major (TFA 0.3% vs. TRA 0.1%, P = 1.0) access site complications. After multivariate analysis, independent predictors of any access site complication included TFA (OR 3.8, 95% CI 1.7-8.3) and dual antiplatelet use (OR 4.9, 95% CI 2.3-10.7). CONCLUSION TFA remains an essential route for neuroendovascular procedures, accounting for 36% of cases under a "radial-first" paradigm. TFA is disproportionately performed in patients at high-risk for access-site complications, though the minor and major complication rate was low in both groups, and the TFA complication rate compares favorably to historical controls. TFA proficiency may still be achieved in "radial-first" training without an increase in femoral complications.