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Patient Preference for Transradial Access over Transfemoral Access for Cerebrovascular Procedures
Sudhakar R Satti1, Ansar Z Vance2, Sohil N Golwala1
1Department of Neurointerventional Surgery, Christiana Care Health System, USA.
Insights
Patients overwhelmingly prefer radial access over femoral access for cerebrovascular procedures. This minimally invasive approach offers comparable safety and comfort, enhancing patient-centered care in neurovascular interventions.
Area of Science:
- Neuroendovascular Surgery
- Vascular Access Techniques
- Patient-Centered Medicine
Background:
- Shared decision-making is crucial in patient-centered care, yet access site selection for neurovascular procedures is often physician-driven.
- Patient preference for specific access sites in neurovascular interventions remains underexplored.
Purpose of the Study:
- To evaluate patient preference for transradial access compared to transfemoral access for cerebrovascular procedures.
- To assess the safety and patient experience associated with transradial access in this context.
Main Methods:
- Prospective, single-center study of 25 patients with prior transfemoral access who underwent transradial cerebrovascular procedures.
- Inclusion criteria: previous transfemoral access, subsequent transradial access.
- Comprehensive pre- and post-procedural assessments, including neurological exams and radial access site evaluation, with 1-2 week outpatient follow-up.
Main Results:
- No major complications (hematomas, infection, delayed radial artery occlusion) were observed.
- Minor post-procedural findings included mild bruising (16%) and mild pain (24%) at the radial access site.
- 24 out of 25 patients (96%) strongly preferred radial access over femoral access for future procedures.
Conclusions:
- Transradial access demonstrates nearly unanimous patient preference for cerebrovascular procedures.
- The radial approach is safe, with no major complications or delayed occlusions in this cohort.
- Given patient preference and safety, the radial approach should be strongly considered for most neurovascular procedures.
Purpose:
Shared decision-making, when physicians and patients collaborate and agree on health care decisions, is a key tenant of patient-centered care. Choice of access site for neurovascular procedures is rarely a shared decision point between physicians and patients. We present our initial evaluation of patient preference for radial over femoral access for cerebrovascular procedures.
Materials And Methods:
IRB approved single-center, prospective, and consecutive survey of all patients undergoing transradial access for cerebrovascular imaging and intervention. Primary inclusion criteria were patients who had previously undergone a transfemoral access procedure and chose to have their second procedure via a transradial approach. All patients underwent pre-procedural neurologic and extremity exams (including Barbeau tests for radial access suitability prior to radial access), post-procedural neurological evaluation and radial access assessment post-procedure, and complete neurological and radial access-site evaluation in the neurointerventional outpatient clinic 1-2 week post-procedure.
Results:
Twenty five consecutive patients who underwent radial access cerebrovascular procedures after previous femoral access cerebrovascular procedures (16 diagnostic angiograms and 9 interventional procedures) were included. No major complications (including hematomas, infection, or delayed radial artery occlusion) were encountered during the immediate post-procedurral period or on outpatient follow-up (average 8 days). On immediate post-procedural examination, 16% had mild bruising and 24% had mild pain at the radial access site. Of the 25 patients included in this study, 24 strongly preferred radial access over femoral access and reported that, if they needed another procedure, they would prefer radial access.
Conclusion:
There was nearly unanimous patient preference for radial over femoral access for cerebrovascular procedures in this single-center prospective analysis. There were no major complications and no incidences of delayed radial occlusion. In the current age of value-based and patient-centered medicine, the radial approach should be considered for nearly all neurovascular procedures.
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