Influence of access site choice for cardiac catheterization on risk of adverse neurological events: a systematic review and meta-analysis

Abstract

Background: Stroke is a rare but potentially catastrophic complication of cardiac catheterization. While 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 re-evaluation 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. Methods and 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 (RR) or the Mantel-Haenszel method for pooling dichotomous data. Pooled data from over 24,000 patients in randomized controlled trials (RCTs) and over 475,000 patients from observational studies were used. The risk ratio for (any) stroke, using RCT 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. This data provides reassurance and should remove another potential barrier to conversion to a ‘default’ radial practice among those who are currently predominantly femoral operators.