Large Single-Center Registry Finds Equally Low Rates of Neurologic Complications in Transradial Versus Transfemoral Procedures

July 9, 2015—A propensity score analysis of 16,710 cases from a single-center prospective registry compared the neurologic complications after a transradial versus a transfemoral approach for diagnostic and interventional cardiac catheterization. The study was published by Luis Raposo, MD, et al in Catheterization and Cardiovascular Interventions (2015;86:61–70).

According to the investigators, the study aimed to assess the association between the risk of stroke/transient ischemic attack (TIA) and a transradial versus a transfemoral access approach. They noted that the transradial approach is increasingly being used as the preferential vascular access site for both diagnostic and interventional procedures, but that there are concerns about the risk of clinically meaningful neurologic complications. 

With low rates of documented stroke/TIA, this observational study suggests that widening the use of transradial access is not associated with an increased risk of clinically relevant procedure-related neurologic complications, concluded the investigators.

As summarized in Catheterization and Cardiovascular Interventions, the investigators analyzed data from 16,710 cases included in the single-center prospective registry between January 2006 and November 2012. The registry is from UNICARV-Hospital De Santa Cruz of Centro Hospitalar De Lisboa Ocidental in Lisbon, Portugal.

Radial procedures were considered as those in which the transradial access was used either primarily (n = 4,195) or after conversion (n = 36). The investigators targeted potential cases with neurologic events by cross-referencing patients who underwent both cardiac catheterization and cranial CT during the same admission episode (n = 67). Procedure-related events were defined as a definitive stroke/TIA nonrelated to coronary artery bypass grafting that occurred within 48 hours of the procedure. 

The investigators reported that transradial access increased from 0.7% in 2006 to 75% in 2012. Total incidence of stroke/TIA was 0.16% and did not change over the study period (P = .26). There was no significant difference in stroke/TIA rates between groups (0.165% vs 0.16%; P = 1). After correction for baseline differences and propensity score matching, transradial access was not an independent predictor of stroke/TIA (odds ratio [OR], 1.21; 95% confidence interval [CI], 0.49–2.98 for stroke and OR, 1.3; 95% CI, 0.55–3.54 for TIA). Results were consistent in prespecified subgroups according to age (≥ 65 years vs < 65 years), gender, interventional versus diagnostic, and acute versus stable coronary syndrome, advised the investigators in Catheterization and Cardiovascular Interventions.