Carotid artery stenting (CAS) delivered via transradial artery access has demonstrated no increased risk of stroke, death, myocardial infarction, transient ischaemic attack, or access site complications, as compared to the more traditional transfemoral approach. That is the concluding finding of a recent Stroke: Vascular and Interventional Neurology publication from Santiago Ortega‐Gutierrez (University of Iowa Hospitals and Clinics, Iowa City, USA) and colleagues.
“The transradial approach shows promise as an alternative method for CAS, offering potential benefits without increased risk of complications,” the authors write. “However, further studies are needed to confirm these findings.”
Ortega-Gutierrez and colleagues initially aver that transfemoral arterial access, while still the most widely used and preferred method for CAS, is associated with “inherent limitations and potential complications”, primarily related to access. The authors further state that positive results and experiences within interventional cardiology have seen transradial displace transfemoral access, becoming the primary approach for many cardiovascular procedures.
“Consequently, exploring transradial artery access as a potential option [due to innovative advances in large bore catheters] becomes crucial in optimising patient outcomes and procedural success rates,” they add, also noting that there are limited data comparing the approach and its outcomes to transfemoral access in CAS.
As such, the authors conducted a systematic review and meta-analysis of the existing literature in this space. From an electronic search of four databases, randomised and non-randomised studies alike involving CAS via transradial or transfemoral approaches were included. Overall, six studies comprising a total of 6,917 patients featured in their analyses. Some 602 of these patients (8.7%) underwent transradial access for the procedure, while 6,315 (91.3%) received transfemoral access.
Ortega-Gutierrez and colleagues’ subsequent meta-analysis showed “no significant difference” between the two access approaches in terms of stroke occurrence, with strokes being observed in 1.7% of patients in the transradial group and 1.9% in the transfemoral group (odds ratio [OR], 0.98). Furthermore, no significant differences were detected regarding death (1% vs. 0.9%, respectively; OR, 0.95), myocardial infarction (0.2% vs. 0.3%; OR, 1.53), transient ischaemic attack (0.4% vs. 1%; OR, 0.46), or access site complications (2.2% vs. 1%; OR, 0.97).
These findings align with other, previously published meta-analyses of the data in this area, according to the authors. However, in contrast to those analyses, the present study employed a Grading of recommendation, assessment, development, and evaluation (GRADE) approach to assess the certainty of the evidence—with the hope of providing “a more comprehensive and robust evaluation of the safety of CAS to better inform decision‐making”.
“Although these results indicate the potential viability of the transradial approach as an alternative to the traditional transfemoral access for CAS, the relatively small number of studies, considerable heterogeneity [in outcome definitions] among them, and the low certainty of evidence, highlight the need for caution in relying on these findings,” Ortega-Gutierrez and colleagues write. “The clinical decision‐making process should therefore be guided by a personalised approach that considers individual patient characteristics and anatomical considerations. Further studies, including RCTs [randomised controlled trials] with larger sample sizes, are warranted to confirm and refine these findings, and to guide clinical decision‐making in the selection of the optimal access approach for CAS.”
