A Comparison of Outcomes Between Transfemoral Versus Transradial Access for Carotid Stenting.
Publication/Presentation Date
8-1-2023
Abstract
BACKGROUND: The transradial (TR) approach has emerged as an alternative to the transfemoral (TF) approach in carotid artery stenting (CAS) because of its perceived benefits in access site complications and overall patient experience.
OBJECTIVE: To assess outcomes of TF vs TR approach for CAS.
METHODS: This is a retrospective single-center review of patients receiving CAS through the TR or TF route between 2017 and 2022. All patients with symptomatic and asymptomatic carotid disease who underwent attempted CAS were included in our study.
RESULTS: A total of 342 patients were included in this study: 232 underwent CAS through TF approach vs 110 through the TR route. On univariate analysis, the rate of overall complications was more than double for the TF vs TR cohort; however, this did not achieve statistical significance (6.5% vs 2.7%, odds ratio [OR] = 0.59 P = .36). The rate of cross-over from TR to TF was significantly higher on univariate analysis (14.6 % vs 2.6%, OR = 4.77, P = .005) and on inverse probability treatment weighting analysis (OR = 6.11, P < .001). The rate of in-stent stenosis (TR: 3.6% vs TF: 2.2%, OR = 1.71, P = .43) and strokes at follow-up (TF: 2.2% vs TR: 1.8%, OR = 0.84, P = .84) was not significantly different. Finally, median length of stay was comparable between both cohorts.
CONCLUSION: The TR approach is safe, feasible, and provides similar rates of complications and high rates of successful stent deployment compared with the TF route. Neurointerventionalists adopting the radial first approach should carefully assess the preprocedural computed tomography angiography to identify patients amenable to TR approach for carotid stenting.
Volume
93
Issue
2
First Page
445
Last Page
452
ISSN
1524-4040
Published In/Presented At
El Naamani, K., Khanna, O., Syal, A., Momin, A. A., Abbas, R., Amllay, A., Sambangi, A., Hunt, A., Dougherty, J., Lawall, C. L., Tjoumakaris, S. I., Gooch, M. R., Herial, N. A., Rosenwasser, R. H., Zarzour, H., Schmidt, R. F., & Jabbour, P. M. (2023). A Comparison of Outcomes Between Transfemoral Versus Transradial Access for Carotid Stenting. Neurosurgery, 93(2), 445–452. https://doi.org/10.1227/neu.0000000000002437
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
36861988
Department(s)
Administration and Leadership
Document Type
Article