Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment
| Autor: | Stefan W Koester, Michael T. Lawton, Neil Majmundar, Andrew F. Ducruet, Daniel D Cavalcanti, Jacob F Baranoski, Tyler S Cole, Tatsuhiro Fujii, D. Andrew Wilkinson, Felipe C. Albuquerque, Joshua S Catapano, Michael J. Lang, Vance L Fredrickson |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Primary outcome Risk Factors Retrospective analysis Medicine Fluoroscopy Humans Complication rate Significant risk Intraoperative Complications Propensity Score Aged Retrospective Studies medicine.diagnostic_test business.industry Endovascular Procedures General Medicine Middle Aged Surgery Femoral Artery Initial phase Radial Artery Female Neurology (clinical) business Complication 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurointerventional surgery. 12(6) |
| ISSN: | 1759-8486 |
| Popis: | BackgroundThe transradial artery (TRA) approach for neuroendovascular procedures continues to gain popularity, but neurointerventionalists still lag behind interventional cardiologists in the adoption of a TRA-first approach. This study compares the complications and efficiency of the TRA approach to the standard transfemoral artery (TFA) approach at our institution during our initial phase of adopting a TRA-first approach.MethodsA retrospective analysis was performed on all consecutive neuroangiographic procedures performed at a large cerebrovascular center from October 1, 2018 to June 30, 2019. The standard TFA approach was compared with TRA access, with the primary outcome of complications analyzed via a propensity-adjusted analysis.ResultsA total of 1050 consecutive procedures were performed on 877 patients during this 9-month period; 206 (20%) procedures were performed via TRA and 844 (80%) via TFA. The overall complication rate was significantly higher with the TFA procedures than with the TRA procedures (7% (60/844) vs 2% (4/206), respectively; p=0.003). A propensity-adjusted analysis showed that the TFA approach was a significant risk factor for a complication (OR 3.6, 95% CI 1.3 to 10.2, p=0.01). However, the propensity analysis showed that fluoroscopy times were on average 4 min less for TFA procedures than for TRA procedures (p=0.003).ConclusionThe TRA approach for neuroendovascular procedures appears to be safer than the TFA approach. Although a steep learning curve is initially encountered when adopting the TRA approach, the transition to a TRA-first practice can be performed safely for neurointerventional procedures and may reduce complications. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|