Influence of access site choice for cardiac catheterization on risk of adverse neurological events: A systematic review and meta-analysis.
BACKGROUND
Stroke is a rare but potentially catastrophic complication of cardiac catheterization. Although some procedural aspects are known to influence stroke risk, the impact of radial versus femoral access site use is unclear. Early observational studies and limited randomized trial data suggested more frequent embolic events with radial access. Subsequently, larger pooled analyses have shown no clear differences in stroke risk but were limited by low event rates. Recent publication of relevant new data prompted our reevaluation of this concern. Therefore, we conducted a systematic review and meta-analysis to evaluate stroke complicating cardiac catheterization with use of transradial versus transfemoral access.


RESULTS
A search of MEDLINE and EMBASE was undertaken using OVID SP with appropriate search terms. RevMan 5.3.5 was used to conduct a random-effects meta-analysis using the inverse variance method for pooling risk ratios (RRs) or the Mantel-Haenszel method for pooling dichotomous data. Pooled data from >24,000 patients in randomized controlled trials and >475,000 patients from observational studies were used. The risk ratio (RR) for (any) stroke, using randomized controlled trial data, was not significant (RR 0.87, 95% CI 0.58-1.29). Using observational data, a significant difference favoring radial access was seen (RR 0.71, 95% CI 0.52-0.98).


CONCLUSIONS
Radial access site utilization for cardiac catheterization is not associated with an increased risk of stroke events. These data provide reassurance and should remove another potential barrier to conversion to a "default" radial practice among those who are currently predominantly femoral operators.
Department of Cardiology, University College London Hospitals and St. Bartholomew's Hospital, London, United Kingdom.
Alex
A
Sirker
Cardiovascular Research Group, Institutes of Science and Technology in Medicine, University of Keele and Institute of Cardiovascular Sciences, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Chun Shing
CS
Kwok
Cardiovascular Research Group, Institutes of Science and Technology in Medicine, University of Keele and Institute of Cardiovascular Sciences, Stoke-on-Trent, United Kingdom.
Rafail
R
Kotronias
Division of Cardiology, University Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada.
Rodrigo
R
Bagur
Quebec Heart-Lung Institute, Laval University, Laval, Quebec, Canada.
Olivier
O
Bertrand
Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Robert
R
Butler
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
Colin
C
Berry
Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
James
J
Nolan
West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.
Keith
K
Oldroyd
Department of Cardiology, University College London Hospitals and St. Bartholomew's Hospital, London, United Kingdom; Cardiovascular Research Group, Institutes of Science and Technology in Medicine, University of Keele and Institute of Cardiovascular Sciences, Stoke-on-Trent, United Kingdom. Electronic address: mamasmamas1@yahoo.co.uk.
Mamas A
MA
Mamas
D006328:Cardiac Catheterization / Q000379:methods*; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D017534:Radial Artery / Q000601:surgery*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*