Aleena Amir Malik, Goodluck Oparaugo, Sajjad Khan, Gaaitri Lohano, Renat Garifullin, Yashfa Asad, Madyana Abdul Rehman, Tooba Ikram Qazi, Faiz Un Nisa, Rehmat Maheen, Rozeen, Adnan Memon, Aroona Devi, Iqra Murtaza, Misbah Parwaiz, Muhammad Huzaifa Khattak, Bilal Wazir Khan
Thirty-two studies (18,953 patients) were included. TRA showed significantly lower total complications (RR 0.63,95% CI 0.43-0.93; p = 0.02), fewer minor complications (RR 0.39,95% CI 0.22-0.68;p = 0.0009), shorter hospital stay (SMD -0.78,95% CI - 1.50 to -0.07;p = 0.03), and reduced immobilization time (SMD -5.81,95% CI - 7.66 to -3.96; p < 0.01); major complications were comparable between groups (RR 0.27; p = 0.24). Overall diagnostic success was similar (RR 0.98,95% CI 0.96-1.00; p = 0.11), though RCTs alone showed significantly lower diagnostic success with TRA (RR 0.96,95% CI 0.93-0.99; p = 0.008). Crossover rates were significantly higher with TRA (RR 3.19,95% CI 1.62-6.28; p = 0.0008). Procedural duration, fluoroscopy time, contrast utilization, and radiation exposure did not differ significantly between groups (p = 0.20-0.89). Radial artery occlusion did not differ significantly between groups (RR 10.93,95% CI 0.50-236.74; p = 0.13).
OBJECTIVE: To compare the safety, efficacy, and patient-centered outcomes of transradial access (TRA) versus transfemoral access (TFA) in patients undergoing diagnostic cerebral angiography.
METHODS: PubMed, Embase, and Scopus were searched from inception through April 2026. RCTs and observational studies comparing TRA with TFA for diagnostic cerebral angiography were included. Random-effects meta-analyses were performed using risk ratios (RRs) for dichotomous outcomes and standardized mean differences (SMDs) for continuous outcomes with 95% confidence intervals.
RESULTS: Thirty-two studies (18,953 patients) were included. TRA showed significantly lower total complications (RR 0.63,95% CI 0.43-0.93; p = 0.02), fewer minor complications (RR 0.39,95% CI 0.22-0.68;p = 0.0009), shorter hospital stay (SMD -0.78,95% CI - 1.50 to -0.07;p = 0.03), and reduced immobilization time (SMD -5.81,95% CI - 7.66 to -3.96; p < 0.01); major complications were comparable between groups (RR 0.27; p = 0.24). Overall diagnostic success was similar (RR 0.98,95% CI 0.96-1.00; p = 0.11), though RCTs alone showed significantly lower diagnostic success with TRA (RR 0.96,95% CI 0.93-0.99; p = 0.008). Crossover rates were significantly higher with TRA (RR 3.19,95% CI 1.62-6.28; p = 0.0008). Procedural duration, fluoroscopy time, contrast utilization, and radiation exposure did not differ significantly between groups (p = 0.20-0.89). Radial artery occlusion did not differ significantly between groups (RR 10.93,95% CI 0.50-236.74; p = 0.13).
DISCUSSION: TRA was associated with fewer complications and faster post-procedural recovery while maintaining broadly comparable overall procedural outcomes. However, the higher crossover rate and modestly lower diagnostic success observed in randomized studies highlight important technical limitations. TRA should therefore be considered a reasonable alternative to TFA, with patient selection, operator experience, and institutional expertise influencing procedural success.