Incidence of periprocedural stroke and transient ischemic attack after transradial or transfemoral approach for diagnostic and interventional cardiac catheterization

Abstract

Introduction: Radial access has gained attention in cardiac catheterization laboratories in the last few years, due to both logistic and clinical reasons, and is being used with increasing frequency worldwide. However, concerns have been raised about the potential increase in the risks of Stroke/Transient Ischemic Attack rates [stroke/TIA]. Aim: To assess the association between the risk of stroke and radial artery vascular access site in current practice of both diagnostic and interventional cardiac procedures. Methods: We retrospectively analyzed the data from of 16.710 diagnostic and interventional procedures, in which there was manipulation of the aortic arch, included in a large volume single-center prospective registry between Jan'2006 and Nov'2012. Radial artery was used as the primary vascular access site in 4.195 cases and 36 patients converted from femoral to radial: the radial-to-femoral conversion rate was 7%. Target cases were identified by cross-matching patients who underwent both cardiac catheterization and cranial-CT during the same admission episode (n=67). Procedure-related events were adjudicated according to a definite diagnosis established by a neurologist, as those occurring within 48 hours after the procedure. For patients discharged before that, subsequent reporting was used. In order to reduce bias, radial procedures were considered as those in which transradial assess was used either primarily of after conversion. Results: Transradial approach increased from 0.7% in 2006 to 75% in 2012, with a sharp change between 2009 and 2010 (5.5% to 36%). Total incidence of stroke/TIA was 0.16% (n=27) and did not change significantly over the study period, despite the increase in radial procedures (p=0.26 for the comparison between years). Overall, we could not demonstrate a significant difference in stroke/TIA rates between patients undergoing cardiac catheterization via radial vs. femoral artery (0.14% vs. 0.16%; p=0.81). Results were consistent in 4 pre-specified sub-groups according to sex, age (≥65 y.o. vs. younger), interventional vs. diagnostic and ACS vs. stable. After correction for important differences in baseline characteristics (using a logistic regression model) radial assess site was not a predictor of stroke/TIA (OR 0.86; 95% CI 0.27-2.7; p=0.80). Conclusion: Stroke/TIA rates were within range of international reports. Our observational study suggests that widening the use of the transradial approach for cardiac catheterization is not associated with an increased risk of clinically relevant procedure-related neurologic complications.