Best of the AANS Session-Discussant Complications of Femoral vs. Radial Access in Neuroendovascular Procedures with Propensity Adjustment

Video Transcription

I would like to thank the AANS for the opportunity to review this manuscript and make some comments.  In their study, they evaluated 206 patients who underwent radial approach and 844 patients who underwent a femoral approach.  As they indicated, their fluoroscopy time was somewhat shorter in the femoral group. This has not been our experience, as I will show you.  Their total contrast load was a little higher in the radial group, but most importantly, complications were significantly less in the transradial group and was statistically  significant. Total minor complications were also far greater in the femoral group, and they had no life-threatening complications whatsoever within the transradial group.  The access crossover site was about 0.89, which is not uncommon. In a study that we published in Stroke in 2019, we evaluated 223 patients.  We had 0% complications requiring an intervention, but 10 patients did complain of discomfort in the radial site.  We also had a 4.3% conversion rate to a femoral approach, either due to vessel size, spasm, or tortuosity.  In an additional paper published in Operative Neurosurgery at the beginning of this year,  we looked at complications from the literature, and in randomized controlled trials, femoral  complications ranged approximately 5.13% and non-randomized controlled trials approximately 2.78%, still significantly higher than the TRA approach.  In our most recent analysis of 760 transradial procedures, we again had a 4.7% conversion to the femoral route, but our minor access complication rate is essentially 0.9%, still  significantly lower than the femoral route, and certainly patient satisfaction is much higher.  So once again, I want to compliment the authors, and I think the TRA is transradial, transfemoral route is here to stay. Thank you.  I also want to thank the AANS for being creative and having this venue to present this work. Congratulations.

Video Summary

In this video, the speaker expresses gratitude to the AANS for allowing them to review a manuscript and make comments. The study discussed evaluated 206 patients who underwent a radial approach and 844 patients who underwent a femoral approach. The speaker disagrees with the study's findings and presents their own experiences. They state that complications were significantly less in the transradial group and total minor complications were higher in the femoral group. They mention their own study, which had no complications requiring intervention but had some patients complaining of discomfort and a conversion rate to the femoral approach. The speaker also references another paper and their recent analysis, showing lower complications and higher patient satisfaction with the transradial approach. They conclude by praising the authors and stating that the transradial route is here to stay. They also express appreciation to the AANS for providing the platform to present this work. No specific credits are granted.

Keywords

radial approach

femoral approach

complications

patient satisfaction

transradial approach