Stroke risk in radial versus femoral approach in coronary intervention: an updated systematic review and meta-analysis

Abstract

Aim Peri-cardiac catheterization (CC) stroke is associated with increased morbidity and mortality. Little is known about any potential difference in stroke risk between transradial (TR) and transfemoral (TF) approaches. We explored this question through a systematic review and meta-analysis. Methods MEDLINE, EMBASE, and PubMed were searched from 1980 to June 2022. Randomized trials and observational studies comparing radial versus femoral access CC or intervention that reported stroke events were included. A random-effects model was used for analysis. Results The total population in our 41 pooled studies comprised 1 112 136 patients – average age 65 years, women averaging 27% in TR and 31% in TF approaches. Primary analysis of 18 randomized–controlled trials (RCTs) that included a total of 45 844 patients showed that there was no statistical significance in stroke outcomes between the TR approach and the TF approach [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.48–1.06, P-value = 0.013, I 2 = 47.7%]. Furthermore, meta-regression analysis of RCTs including procedural duration between those two access sites showed no significance in stroke outcomes (OR 1.08, 95% CI 0.86–1.34, P-value = 0.921, I 2 = 0.0%). Conclusions There was no significant difference in stroke outcomes between the TR approach and the TF approach.