Avoiding the Radial Paradox: Neuroendovascular Femoral Access Outcomes After Radial Access Adoption

BACKGROUND: Transradial access (TRA) for neuroendovascular procedures is increasing in prevalence. The safety benefits of TRA at a patient level may be offset at a population level by a paradoxical increase in transfemoral access (TFA) vascular access site complications (VASCs), the so-called radial paradox. OBJECTIVE: To study the effect of TRA adoption on TFA performance and outcomes in neuroendovascular procedures. METHODS: Data were collected for all procedures performed over a 10-mo period after radial adoption at a single center. RESULTS: Over the study period, 1084 procedures were performed, including 719 (66.3%) with an intent to treat by TRA and 365 (33.7%) with an intent to treat by TFA. Thirty-two cases (4.4%) crossed over fromTRA to TFA, and 2 cases (0.5%) crossed over fromTFA to TRA. TFA was performed in older patients (mean [standard deviation] TFA, 63 [15] vs TRA, 56 [16] years) using larger sheath sizes (>= 7 French; TFA, 56.2% vs TRA, 2.3%) (P <.001 for both comparisons). Overall, 29 VASCs occurred (2.7%), including 27 minor (TFA, 4.6% [18/395] vs TRA, 1.3% [9/689], P =.002) and 2 major (TFA, 0.3% [1/395] vs TRA, 0.1% [1/689], P >.99) complications. Independent predictors of VASC included TFA (OR 2.8, 95% confidence interval [CI] 1.1-7.4) and use of dual antiplatelet therapy (OR 4.2, 95% CI 1.6-11.1). CONCLUSION: TFA remains an important access route, despite a predominantly radial paradigm, and is disproportionately used in patients at increased risk for VASCs. TFA proficiency may still be achieved in predominantly radial practices without an increase in femoral complications.

Automated summary

The adoption of TRA in neuroendovascular procedures has an impact on the performance and outcomes of TFA. Despite being an important access route, TFA is used disproportionately in high-risk patients and has a higher complication rate.