Trans-radial vs. trans-femoral approaches in diagnostic cerebral angiography: A comprehensive systematic review and meta-analysis of practicality and cost-effectiveness

Background: Selecting most appropriate approach between the transfemoral access (TFA) and transradial access (TRA) for diagnostic cerebral angiography is a subject of debate. Objective: To compare the safety and efficacy of TFA and TRA for diagnostic cerebral angiography. Methods: We performed a systematic search through four databases to find relevant clinical studies. Binary outcomes were analyzed and reported through the odds ratio (OR) and 95 % confidence interval (CI), while continuous outcomes were analyzed and reported through the standardized mean difference (SMD) and 95 % CI. Results: We included 12,693 patients from 24 studies that evaluated the TRA vs TFA in diagnostic cerebral angiography. There was no significant difference between TRA and TFA in total (SMD = -0.78, P = 0.51) and sheath (SMD = -3.31, P = 0.6) costs, the hyperintense foci on diffusion-weighted MRI (OR = 7.15, P = 0.22), fluoroscopy time (SMD = 0.022, P = 0.83), procedure time (SMD = -0.42, P = 0.14), radiation exposure (SMD = -0.06, P = 0.81), and total contrast utilization (SMD = -0.26, P = 0.24). The success rate (OR = 0.54, P = 0.0065) and total complication (OR = 0.5, P = 0.02) were significantly lower in TRA. Subgroup analysis showed no significant difference between senior and fellow neurointerventionalists in total complications (P=0.09), success rate (P=0.62), and fluoroscopy time (P=0.35). Conclusions: TRA was associated with lower complications than TFA for diagnostic cerebral angiography, but the higher incidence of MRI-detected diffusion-weighted microemboli necessitates careful patient selection and procedural planning.