title: Neurologic complications after transradial or transfemoral approach for diagnostic and interventional cardiac catheterization: A propensity score analysis of 16,710 cases from a single centre prospective registry.
abstract: OBJECTIVE
  Transradial approach (TRA) is being used increasingly as the preferential vascular access site for both diagnostic and interventional procedures. However, concerns have risen about the risk of clinically meaningful neurologic complications. We aimed to assess the association between the risk of stroke/transient ischemic attack (TIA) and the transradial (vs. transfemoral) approach.
  
  
  RESULTS
  Data from 16,710 cases included in a single centre prospective registry between January 2006 and November 2012 was analyzed. Radial procedures were considered as those in which the radial access was used either primarily (n = 4,195) or after conversion (n = 36). Potential cases with neurologic events were targeted by cross-referencing patients who underwent both cardiac catheterization and cranial-computed tomography (cranial-CT) during the same admission episode (n = 67). Procedure-related events were defined as a definitive non-CABG related stroke/TIA occurring within 48 hr of the procedure. TRA 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 = 0.26). There was no significant difference in stroke/TIA rates between groups (0.165% vs. 0.160%; P = 1.0). After correction for baseline differences and propensity score matching, TRA was not an independent predictor of stroke/TIA (OR 1.21; 95% CI 0.49-2.98 and 1.3; 95% CI 0.55-3.54, respectively). Results were consistent in pre-specified sub-groups according to age (≥65 y.o. vs. younger), gender, interventional vs. diagnostic and ACS vs. stable.
  
  
  CONCLUSIONS
  Rates of documented stroke/TIA were low. Our observational study suggests that widening the use of the TRA is not associated with an increased risk of clinically relevant procedure-related neurologic complications.
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: Luis
authors: L
authors: Raposo
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: Sérgio
authors: S
authors: Madeira
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: Rui Campante
authors: RC
authors: Teles
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: Miguel
authors: M
authors: Santos
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: Henrique Mesquita
authors: HM
authors: Gabriel
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: Pedro
authors: P
authors: Gonçalves
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: João
authors: J
authors: Brito
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: Silvio
authors: S
authors: Leal
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: Manuel
authors: M
authors: Almeida
authors: Cardiology Department - UNICARV, Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.
authors: Miguel
authors: M
authors: Mendes
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011174:Portugal / Q000453:epidemiology; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D017534:Radial Artery; D012042:Registries; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*
keywords: coronary angiography; percutaneous coronary intervention; stroke; transradial