Feasibility and Safety of Transradial Aneurysm Embolization: A Systematic Review and Meta-analysis

• Published in: World neurosurgery 2022-09, Vol.165, p.e110-e127
• Main Authors: Alkhars, Hussain, Haq, Waqas, Al-tayeb, Ahmed, Sigounas, Dimitri
• Format: Article
• Language: English
• Subjects: Cerebral Aneurysm; Coiling; Distal Radial Artery Access; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Endovascular; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; Feasibility Studies; Flow Diversion; Humans; Intracranial Aneurysm - surgery; Radial Artery - surgery; Radial Artery Access; Retrospective Studies; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2022.05.112

Use of the transradial access (TRA) approach for neuroendovascular procedures has been increasing in recent years. Our aim is to assess the feasibility, success rate, and complications associated with TRA for intracranial aneurysm embolization. PubMed, Scopus, and Embase were systematically searched for studies using TRA for intracranial aneurysm embolization. Random-effects models were used to obtain pooled rates of procedural success and complications. Twenty-four studies comprising 1283 (85.9%) TRA and 122 (8.2%) distal TRA aneurysm embolization procedures were included. The pooled success rate of the 18 studies in the meta-analysis was 93.5% (95% confidence interval [CI], 91.1%-95.8%). The pooled thromboembolic complication rate was 0.5% (95% CI, 0.1%-0.9%), the hemorrhagic complication rate was 0.5% (95% CI, 0.1%-0.9%), and the access site complication rate was 0.8% (95% CI, 0.3%-1.3%). One study (4.3%) used exclusively a 7-French guide catheter, and most used a 6-French guide catheter (22 of 23 studies, 95.7%), which was further incorporated as part of a triaxial configuration through a sheathless 8-French system in 4 studies (17.4%), 7-French guide catheter in 2 studies (8.7%), and 8-French sheath in 1 study (4.3%). The embolization techniques used were flow diverter placement in 451 cases (39.1%), coiling in 376 (32.6%), stent-assisted coiling in 127 (11.0%), balloon-assisted coiling in 104 (9.0%), Woven EndoBridge system in 50 (4.3%), and flow diverter placement plus coiling in 42 (3.6%). Treating intracranial aneurysms using various embolization techniques through TRA is feasible and associated with low access site and intraoperative complications.