Transradial versus transfemoral access for embolization of intracranial aneurysms with the Woven EndoBridge device: a propensity score–matched study

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  • 1 Neuroradiology & Neurointervention Service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA;
  • | 2 Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA;
  • | 3 Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael’s Hospital, University of Toronto, ON, Canada;
  • | 4 Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA;
  • | 5 Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France;
  • | 6 Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy;
  • | 7 Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY;
  • | 8 Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland;
  • | 9 Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany;
  • | 10 Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA;
  • | 11 Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina;
  • | 12 Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL;
  • | 13 Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center "Sisters of Mercy," Zagreb, Croatia;
  • | 14 Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX;
  • | 15 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ;
  • | 16 Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY;
  • | 17 Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia;
  • | 18 Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA;
  • | 19 Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy;
  • | 20 Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA;
  • | 21 Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy;
  • | 22 Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgium;
  • | 23 Department of Neurosurgery, University of Miami, Miami, FL;
  • | 24 Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX;
  • | 25 Department of Neurosurgery, University of Alabama at Birmingham, AL; and
  • | 26 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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OBJECTIVE

Transradial access (TRA) is commonly utilized in neurointerventional procedures. This study compared the technical and clinical outcomes of the use of TRA versus those of transfemoral access (TFA) for intracranial aneurysm embolization with the Woven EndoBridge (WEB) device.

METHODS

This is a secondary analysis of the Worldwide WEB Consortium, which comprises multicenter data related to adult patients with intracranial aneurysms who were managed with the WEB device. These aneurysms were categorized into two groups: those who were treated with TRA or TFA. Patient and aneurysm characteristics and technical and clinical outcomes were compared between groups. Propensity score matching (PSM) was used to match groups according to the following baseline characteristics: age, sex, subarachnoid hemorrhage, aneurysm location, bifurcation aneurysm, aneurysm with incorporated branch, neck width, aspect ratio, dome width, and elapsed time since the last follow-up imaging evaluation.

RESULTS

This study included 682 intracranial aneurysms (median [interquartile range] age 61.3 [53.0–68.0] years), of which 561 were treated with TFA and 121 with TRA. PSM resulted in 65 matched pairs. After PSM, both groups had similar characteristics, angiographic and functional outcomes, and rates of retreatment, thromboembolic and hemorrhagic complications, and death. TFA was associated with longer procedure length (median 96.5 minutes vs 72.0 minutes, p = 0.006) and fluoroscopy time (28.2 minutes vs 24.8 minutes, p = 0.037) as compared with TRA. On the other hand, deployment issues were more common in those treated with TRA, but none resulted in permanent complications.

CONCLUSIONS

TRA has comparable outcomes, with shorter procedure and fluoroscopy time, to TFA for aneurysm embolization with the WEB device.

ABBREVIATIONS

IQR = interquartile range; mRS = modified Rankin Scale; PSM = propensity score matching; TFA = transfemoral access; TRA = transradial access; WEB = Woven EndoBridge.

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