Abstract Background Cerebral angiography is the gold standard for the diagnosis of cerebrovascular disease. Transfemoral access (TFA) has been the conventional approach for angiography, but concerns regarding access-site complications have led to the increasing adoption of the transradial approach (TRA). This systematic review and meta-analysis aimed to compare the safety and efficacy of transradial access (TRA) versus transfemoral access (TFA) in patients undergoing diagnostic cerebral angiography (DCA). Method Following an extensive electronic search of PubMed, Embase, Cochrane and ClinicalTrials.gov, eligible RCTs and prospective observational studies encompassing patients undergoing DCA using TRA and TFA were included in the pooled analysis. Quality was assessed by Rob 2.0 tool and Newcastle-Ottawa scale (NOS) while certainty of evidence was evaluated through GRADE. Dichotomous variables were pooled as risk ratio (RR) and continuous variables as mean difference (MD) with a random effects model. Heterogeneity was assessed using the I² statistic, and sensitivity analyses were conducted when substantial heterogeneity was present. Results Nine studies (4 RCTs and 5 prospective observational studies) involving 4,827 patients were included. Procedural success was comparable between the TRA and TFA groups. TRA was associated with significantly higher crossover rates (RR 3.03, 95% CI 1.26–7.32; P = 0.01; I 2 = 29%) and a shorter time to ambulation (MD − 14.69 h; P < 0.00001). TRA was associated with significantly lower total complications (RR 0.56, 95%CI 0.34–0.93; P = 0.02), while access-site complications trended to be lower with TRA but did not reach statistical significance (RR 0.40, 95% CI 0.16–1.02; P = 0.06). TRA was associated with longer procedure time (MD + 4.19 min; P < 0.00001), while no significant differences were observed in neurological complications, fluoroscopy time, contrast volume, or radiation dose. The certainty of evidence ranged from moderate to low. Conclusion TRA and TFA demonstrated comparable safety and procedural efficacy for diagnostic cerebral angiography. While TRA is associated with higher crossover rates and slightly longer procedure times, it offers the important advantages of earlier ambulation and is associated with fewer overall complications. Access selection should be guided by the patient characteristics, operator experience, and institutional expertise. Further adequately powered randomized controlled trials are warranted to validate these findings and clarify the optimal access strategy.
Khan et al. (Mon,) studied this question.