• Bradley Kolb, Krishna Joshi, Justin Sim, Yazan Radaideh, Michael Chen, R Webster Crowley, and Stephan Munich.
• Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address: bradley_kolb@rush.edu.
• World Neurosurg. 2024 Apr 1; 184: e32e38e32-e38.

BackgroundFemoral access (TFA) for neuroendovascular procedures may present a challenge in very high body mass index (BMI) individuals. Whether radial access (TRA) confers a comparative benefit in this specific population has not been studied.MethodsWe retrospectively identified all patients undergoing neuroendovascular procedures at our center between 2017 and 2021 with BMI ≥35 kg/m2. A total of 335 patients met our inclusion criteria, with 224 undergoing femoral access and 111 undergoing radial access. Electronic medical records were reviewed for baseline clinical and angiographic characteristics and procedural outcomes.ResultsThe primary outcome of any bleeding complication occurred in 7% of the femoral group and 2% of the radial group (odds ratio 4.2, 95% confidence interval 1.0-18.6, P = 0.0421). Radial access was also associated with significantly shorter mean procedure times (median 43 minutes for radial, median 58 minutes for femoral, P = 0.0009) and mean fluoroscopy exposure times (median 15 minutes for radial, median 20 minutes for femoral, P = 0.0003). There were no significant differences in nonaccess site complications, procedural failure, length of stay, or deaths during hospitalization.ConclusionsWhen compared to TRA, TFA was associated with a significantly greater rate of bleeding complications in very high BMI patients undergoing neuroendovascular procedures. Procedure time and fluoroscopy time were both significantly longer when using TFA compared to TRA in this patient population.Copyright © 2023 Elsevier Inc. All rights reserved.

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