• D Andrew Wilkinson, Neil Majmundar, Joshua S Catapano, Tyler S Cole, Jacob F Baranoski, Benjamin K Hendricks, Daniel D Cavalcanti, Vance L Frederickson, Andrew F Ducruet, and Felipe C Albuquerque.
• Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
• Neurosurgery. 2022 Mar 1; 90 (3): 287292287-292.

BackgroundTransradial access (TRA) for neuroendovascular procedures is increasing in prevalence. The safety benefits of TRA at a patient level may be offset at a population level by a paradoxical increase in transfemoral access (TFA) vascular access site complications (VASCs), the so-called "radial paradox."ObjectiveTo study the effect of TRA adoption on TFA performance and outcomes in neuroendovascular procedures.MethodsData were collected for all procedures performed over a 10-mo period after radial adoption at a single center.ResultsOver the study period, 1084 procedures were performed, including 719 (66.3%) with an intent to treat by TRA and 365 (33.7%) with an intent to treat by TFA. Thirty-two cases (4.4%) crossed over from TRA to TFA, and 2 cases (0.5%) crossed over from TFA to TRA. TFA was performed in older patients (mean [standard deviation] TFA, 63 [15] vs TRA, 56 [16] years) using larger sheath sizes (≥7 French; TFA, 56.2% vs TRA, 2.3%) ( P < .001 for both comparisons). Overall, 29 VASCs occurred (2.7%), including 27 minor (TFA, 4.6% [18/395] vs TRA, 1.3% [9/689], P = .002) and 2 major (TFA, 0.3% [1/395] vs TRA, 0.1% [1/689], P > .99) complications. Independent predictors of VASC included TFA (OR 2.8, 95% confidence interval [CI] 1.1-7.4) and use of dual antiplatelet therapy (OR 4.2, 95% CI 1.6-11.1).ConclusionTFA remains an important access route, despite a predominantly radial paradigm, and is disproportionately used in patients at increased risk for VASCs. TFA proficiency may still be achieved in predominantly radial practices without an increase in femoral complications.Copyright © Congress of Neurological Surgeons 2021. All rights reserved.

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