Lower complication rates associated with transradial versus transfemoral flow diverting stent placement

Yangchun Li; Stephanie H Chen; Alejandro M Spiotta; Pascal Jabbour; Michael R Levitt; Peter Kan; Christoph J Griessenauer; Adam S Arthur; Joshua W Osbun; Min S Park; Nohra Chalouhi; Ahmad Sweid; Stacey Q Wolfe; Kyle M Fargen; Aaron S Dumont; Travis M Dumont; Marie-Christine Brunet; Samir Sur; Evan Luther; Allison Strickland; Dileep R Yavagal; Eric C Peterson; Clemens M Schirmer; Oded Goren; Shamsher Dalal; Gregory Weiner; Axel Rosengart; Daniel Raper; Ching-Jen Chen; Peter Amenta; Tyler Scullen; Cory Michael Kelly; Christopher Young; Michael Nahhas; Eyad Almallouhi; Arunprasad Gunasekaran; Suhas Pai; Giuseppe Lanzino; Waleed Brinjikji; Mehdi Abbasi; David Dornbos Iii; Nitin Goyal; Jeremy Peterson; Mohammad H El-Ghanem; Robert M Starke

doi:10.1136/neurintsurg-2020-015992

Lower complication rates associated with transradial versus transfemoral flow diverting stent placement

J Neurointerv Surg. 2021 Jan;13(1):91-95. doi: 10.1136/neurintsurg-2020-015992. Epub 2020 Jun 2.

Authors

Yangchun Li^#¹, Stephanie H Chen^#², Alejandro M Spiotta³, Pascal Jabbour⁴, Michael R Levitt⁵, Peter Kan⁶, Christoph J Griessenauer^{7

8}, Adam S Arthur^{9

10}, Joshua W Osbun¹¹, Min S Park¹², Nohra Chalouhi⁴, Ahmad Sweid⁴, Stacey Q Wolfe¹³, Kyle M Fargen¹⁴, Aaron S Dumont¹⁵, Travis M Dumont¹⁶, Marie-Christine Brunet², Samir Sur¹, Evan Luther², Allison Strickland², Dileep R Yavagal¹⁷, Eric C Peterson¹⁸, Clemens M Schirmer^{7

19}, Oded Goren²⁰, Shamsher Dalal⁷, Gregory Weiner²¹, Axel Rosengart⁷, Daniel Raper²², Ching-Jen Chen²³, Peter Amenta²⁴, Tyler Scullen²⁵, Cory Michael Kelly²⁶, Christopher Young²⁶, Michael Nahhas²⁷, Eyad Almallouhi²⁷, Arunprasad Gunasekaran³, Suhas Pai³, Giuseppe Lanzino²⁸, Waleed Brinjikji²⁹, Mehdi Abbasi²⁸, David Dornbos Iii^{30

31}, Nitin Goyal³², Jeremy Peterson^{10

33}, Mohammad H El-Ghanem³⁴, Robert M Starke^{35

36}

Affiliations

¹ Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
² Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
³ Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
⁴ Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁵ Neurological Surgery, Radiology and Mechanical Engineering and Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington, USA.
⁶ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
⁷ Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA.
⁸ Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria.
⁹ Department of Neurological Surgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
¹⁰ Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹¹ Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
¹² Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
¹³ Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
¹⁴ Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA.
¹⁵ Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA.
¹⁶ Neurosurgery, Neurology and Medical Imaging, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA.
¹⁷ Neurology and Neurosurgery, University of Miami, Miami, Florida, USA.
¹⁸ Neurological Surgery, University of Miami, Miami, Florida, USA.
¹⁹ Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria.
²⁰ Neurosurgery, Geisinger, Danville, Pennsylvania, USA.
²¹ Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.
²² Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
²³ Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
²⁴ Neurological Surgery, Tulane Medical Center Downtown, New Orleans, Louisiana, USA.
²⁵ Neurosurggery, Tulane University, New Orleans, Louisiana, USA.
²⁶ Neurological Surgery, University of Washington, Seattle, Washington, USA.
²⁷ Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
²⁸ Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
²⁹ Neurosurgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
³⁰ Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA.
³¹ Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
³² Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
³³ Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
³⁴ Neurosurgery, Neurology and Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona, USA.
³⁵ Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA RStarke@med.miami.edu.
³⁶ Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA.

^# Contributed equally.

Abstract

Background: Currently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion.

Methods: We retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches.

Results: A total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035).

Conclusion: TRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series.

Keywords: aneurysm; artery; complication; flow diverter; intervention.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Adult
Aged
Catheterization, Peripheral / adverse effects
Catheterization, Peripheral / methods
Catheterization, Peripheral / trends
Cohort Studies
Endovascular Procedures / adverse effects
Endovascular Procedures / methods
Endovascular Procedures / trends*
Female
Femoral Artery / diagnostic imaging
Femoral Artery / surgery*
Humans
Intracranial Aneurysm / diagnostic imaging
Intracranial Aneurysm / surgery*
Male
Middle Aged
Postoperative Complications* / diagnostic imaging
Postoperative Complications* / etiology
Radial Artery / diagnostic imaging
Radial Artery / surgery*
Registries
Retrospective Studies
Self Expandable Metallic Stents / adverse effects
Self Expandable Metallic Stents / trends*
Time Factors
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding