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Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis.
- Source :
-
Journal of neurointerventional surgery [J Neurointerv Surg] 2020 Jan; Vol. 12 (1), pp. 87-93. Date of Electronic Publication: 2019 Jun 14. - Publication Year :
- 2020
-
Abstract
- Background: Femoral access is the traditional approach for endovascular carotid artery stenting. Radial access is increasingly used as an alternative approach due to its known anatomical advantages in patients with unfavorable aortic arch morphology via the femoral approach and its excellent access site safety profile. Our objective was to analyze procedural success using radial access for carotid artery stenting as reported in the literature.<br />Methods: Three online databases were systematically searched following PRISMA guidelines for studies (n ≥20) using radial artery access for carotid artery stenting (1999-2018). Random-effects meta-analysis was used to pool the procedural success (successful stent placement with no requirement for crossover to femoral access), mortality, and complication rates associated with radial access.<br />Results: Seven eligible studies reported procedural success outcomes with a pooled meta-analysis rate of 90.8% (657/723; 95% CI 86.7% to 94.2%; I <superscript>2</superscript> =53.1%). Asymptomatic radial artery occlusion occurred in 5.9% (95% CI 4.1% to 8.0%; I <superscript>2</superscript> =0%) and forearm hematoma in 1.4% (95% CI 0.4% to 2.9%; I <superscript>2</superscript> =0%). Risk of minor stroke/transient ischemic attack was 1.9% (95% CI 0.6% to 3.8%; I <superscript>2</superscript> =42.3%) and major stroke was 1.0% (95% CI 0.4% to 1.8%; I <superscript>2</superscript> =0%). There were three deaths across the seven studies (0.6%; 95% CI 0.2% to 1.3%; I <superscript>2</superscript> =0%). The meta-analysis was limited by statistically significant heterogeneity for the primary outcome of procedural success.<br />Conclusion: Radial access for carotid artery stenting has a high procedural success rate with low rates of mortality, access site complications, and cerebrovascular complications. The potential benefits of this approach in patients with unfavorable aortic arch access should be explored in a prospective randomized trial.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Carotid Arteries diagnostic imaging
Carotid Stenosis diagnostic imaging
Humans
Ischemic Attack, Transient diagnostic imaging
Ischemic Attack, Transient surgery
Prospective Studies
Radial Artery diagnostic imaging
Stroke diagnostic imaging
Stroke surgery
Treatment Outcome
Carotid Arteries surgery
Carotid Stenosis surgery
Radial Artery surgery
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1759-8486
- Volume :
- 12
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of neurointerventional surgery
- Publication Type :
- Academic Journal
- Accession number :
- 31201288
- Full Text :
- https://doi.org/10.1136/neurintsurg-2019-014994