Transradial Access Versus Transfemoral Approach for Carotid Artery Stenting: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiovascular Interventions
• Vascular Surgery
• Interventional Radiology

Background:

• Carotid artery stenting (CAS) is a key treatment for high-risk patients with carotid artery stenosis.
• Transfemoral arterial access is standard but has limitations.
• Transradial artery access is being explored as an alternative to improve patient outcomes.

Purpose of the Study:

• To systematically review and meta-analyze outcomes and complication rates of transradial versus transfemoral access for CAS.
• To compare stroke, TIA, death, MI, and access site complications between the two approaches.

Main Methods:

• Systematic electronic search of 4 databases for relevant studies (randomized and non-randomized).
• Inclusion of studies involving CAS via transradial or transfemoral access.
• Meta-analysis of pooled odds ratios (ORs) and 95% CIs to assess effect size.

Main Results:

• Six studies with 6917 patients (602 transradial, 6315 transfemoral) were analyzed.
• No significant differences found in stroke (1.7% vs 1.9%), death (1% vs 0.9%), MI (0.2% vs 0.3%), or TIA (0.4% vs 1%).
• Access site complication rates were similar (2.2% vs 1%).

Conclusions:

• Transradial and transfemoral approaches for CAS demonstrate comparable safety profiles.
• Transradial access is a promising alternative for CAS, potentially offering benefits without increased risks.
• Further research is warranted to confirm these findings and explore long-term outcomes.