Transradial versus transfemoral access in carotid artery stenting: A meta-analysis

Background The carotid artery stenting (CAS) has two common access sites: transradial access (TRA) and transfemoral access (TFA). However, there's no definitive answer to which one is superior. Objective Compare TRA and TFA for the CAS. Methods A systematic review of the literature of studies reporting both TRA and TFA results was conducted following the PRISMA guidelines. PubMed, Cochrane Library, Web of Science and Embase were queried. Results The meta-analysis examined nine studies comprising 7513 patients who underwent CAS. Of these, 6750 patients had TFA (90%), while 763 had TRA (10%). There was no significant difference in procedure success rates between TRA and TFA, with a risk ratio (RR) of 0.99 (6/9; 95% CI 0.98 to 1.00; I² = 9%, fixed effects). However, cross-over to TFA was more frequent in TRA (odds ratio (OR) 10.37 (6/9; 95% CI 5.18 to 20.77; I² = 17%, fixed effects)). There were no significant differences in terms of major access complications (RR = 0.88 (7/9; 95% CI: 0.29 to 2.63; I² = 0, fixed effects)), total access complications (RR = 1.10 (6/9; 95% CI: 0.56 to 2.15; I² = 7%, fixed effects)), and mean difference in length of stay (Mean difference of −0.08 (3/9; 95% CI −0.18 to 0.02; I² = 0%, fixed effects)). Conclusion There were no significant differences between TFA and TRA in terms of procedure success rates, time, complications, and length of stay, although cross-over to TFA was more common in TRA cases.