Details

Autor(en) / Beteiligte

• Catapano, Joshua
• Nguyen, Candice
• Cole, Tyler S
• Baranoski, Jacob F
• Majmundar, Neil J
• Wilkinson, D. Andrew
• Cavalcanti, Daniel D
• Fredrickson, Vance
• Ducruet, Andrew F
• Albuquerque, Felipe

Titel

Propensity Adjusted Comparative Analysis of Radial and Femoral Access for Neurointerventional Treatments

Ist Teil von

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

Ort / Verlag

Philadelphia: Wolters Kluwer Health, Inc

Erscheinungsjahr

2020

Link zum Volltext

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• INTRODUCTION Transradial artery (TRA) catherization for neuroendovascular procedures is effective and associated with less complications than transfemoral procedures. However, the majority of literature for TRA is limited to series with a high proportion of diagnostic procedures METHODS All patients with an endovascular intervention from 10/1/2018 to 12/31/2019 performed at a single center were retrospectively analyzed. Patients were grouped into two cohorts: TRA versus TFA access. Primary outcomes included complications and access site cross-over. Secondary outcomes analyzed were mean fluoroscopy time and contrast amount. RESULTS 579 neurointerventional treatments were performed during the 15-month period. 163 (28%) procedures were initially attempted via a TRA and the remaining 416 (72%) via TFA. Of the 163 attempted TRA procedures, 7 (4%) crossovers (4 aneurysm embolizations, 2 thrombectomies for acute stroke, and 1 AVM embolization with 6 crossing over to TFA) vs 13 (3.1%) (5 crossing over to TRA) in the TFA procedures occurred (P = .49). Of the 162 TRA treatments that were carried out accounting for crossovers, 80 (35%) were for aneurysmal embolization, 31 embolization (19%) of an AVM/AVF, 4 (3%) thrombectomies of an acute stroke, 9 (6%) carotid artery stenting/angioplasty, 8 (5%) tumor embolization, 24 (15%) middle meningeal artery embolization for cSDH, and 6 (4%) other neurointerventions. The TRA procedures were significantly different than the 417 TFA procedures performed, which included 143 (34%) thrombectomies for acute stroke (P < .001). A significantly greater fluoroscopy time (39 vs 30 minutes) and total contrast (156 vs 128 mL) were observed in the TRA procedures (P < .001). TFA procedures (N = 43,10%) were associated with a higher complication rate than TRA procedures (N = 5,4%) (P = .008); however, the majority of complications were mild with only 18 (3%) major complications including three in the TRA procedures and 15 in the TFA interventions. After eliminating thrombectomy patients and performing a propensity adjustment (age, gender, symptoms, procedure, pathology, sheath and catheter size) TRA catheterization was associated with decreased odds of a complication (OR 0.25,95% CI: 0.085-0.72, P = .011) and greater contrast amount (161 vs 140mL, P = .007), but no difference in fluoroscopy time (39 vs 35 minutes, P = .052) than TFA treatments. CONCLUSION TRA access for neuroendovascular interventions can be performed successfully and efficiently for a variety of procedures and for numerous pathologies, with fewer overall complications than the traditional TFA approach.