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March 9, 2020

Transradial Access for Neurointerventions Supported by Systematic Review of the Literature

March 9, 2020—A systematic literature review of the use of transradial access (TRA) for neurointerventional cases found that the TRA approach demonstrated a relatively low rate of access site complications and crossovers. Krishna C. Joshi, MD, et al published the findings online in Journal of NeuroInterventional Surgery (JNIS).

The investigators stated that with increasing familiarity, the development of TRA-specific neuroendovascular devices, and the continued reports of its success in the literature, TRA is expected to become more widely used by neurointerventionalists.

As summarized in JNIS, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed in the systematic literature review that included searches of three online databases (MedLine via PubMed, Scopus, and Embase) for articles published between January 2000 and December 2019. Search terms included neurointerventions plus transradial access or radial access or radial artery. The reference lists of selected articles and pertinent available nonsystematic analysis were reviewed for other potential citations.

The review included 21 studies (N = 1,342 patients), two of which were prospective and 19 were retrospective. Six studies (n = 616 patients) included TRA carotid stenting only. The rest of the studies included treatment for cerebral aneurysms (n = 423), mechanical thrombectomy (n = 127), tumor embolization (n = 22), and other indications (n = 154) such as angioplasty and stenting for vertebrobasilar stenosis, balloon test occlusion, embolization of dural arteriovenous fistula and arteriovenous malformation, chemotherapeutic drug delivery, intra-arterial thrombolysis, and arterial access during a venous stenting procedure.

Primary outcomes measured were access site complications and crossover rates.

In the literature, two (0.15%) major complications and 37 (2.75%) minor complications were recorded. Sixty-four (4.77%) patients crossed over to transfemoral access for completion of the procedure. Seven (0.52%) patients crossed over because of access failure and 57 (4.24%) patients crossed over to transfemoral access because of inability to cannulate the target vessel, reported the investigators in JNIS.

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