706 Radial Versus Femoral Access for Diagnostic Cerebral Angiography: A Systematic Review and Meta-analysis of Randomized Trials

Abstract

INTRODUCTION: Radial artery access is the gold standard for percutaneous coronary procedures, desmonstrating benefits for patient safety and comfort, its adoption for diagnostic cerebral angiography has been limited by doctors’ concerns about achieving procedural success. METHODS: PubMed, Embase and Cochrane databases were searched through April 2023. Statistical analysis were performed using R version 4.2.3. Random-effects meta-analysis with risk ratio (RR) and 95% CI were estimated using the inverse variance and Mantel-Haenszel method for binary outcomes and DerSimonian-Laird estimator for continuous outcomes. The primary outcome was technical success, and the secondary outcomes were procedure time, radiation exposure and fluoroscopy. RESULTS: After reviewing 142 studies, were included 3 randomized trials involving 492 patients with 250 patients in radial group (50.81%) and 242 in femoral (49.19%). The total mean age of the patients was 57 years old, 249 males (50.61%) and 243 females (49.39%). There is no significant difference in technical success (RR 0.99, 95% CI 0.94 to 1.03, p = 0.555, I2 = 0%), procedure time (WMD 2.08 minutes, 95% CI -5.11 to 9.28, p = 0.570, I2 = 87%) and radiation exposure also showed no significant difference (WMD 27.87 mGy, 95% CI -21.43 to 77.17, p=0.268, I2 = 0%). Fluoroscopy time had high heterogeneity and a non-significant result (WMD 2.70 minutes, 95% CI -0.73 to 6.13, p = 0.123, I2 = 82%). The funnel plots showed roughly inverted symmetrical distributions among study points which indicated the lack of any preliminary publication bias. Leave-one-out sensitivity analysis determined that the final pooled results were unstable. CONCLUSIONS: The findings suggest that the procedures studied have similar technical success rates and radiation exposure. Studies are needed to explore the factors contributing to heterogeneity in procedure and fluoroscopy times to optimize safety and efficiency in radial or femoral access.