Trans-radial versus trans-femoral approach for cerebral angiography: a meta-analysis of randomized controlled trials

Introduction
Both the trans-radial approach (TRA) and the trans-femoral approach (TFA) have been employed for cerebral angiography, but the relative advantages of these two techniques remain uncertain. Aim: To compare the relative safety and efficacy of the TRA and TFA when conducting cerebral angiography.

Material and methods
Relevant studies published up to August 2022 were identified in the PubMed, Embase, and Wanfang databases. The rate of successful cerebral angiography was the primary study endpoint, while secondary endpoints included successful puncture rates, operative duration, puncture time, fluoroscopic duration, complication rates, and duration of postoperative recovery.

Results
This meta-analysis incorporated 6 randomized controlled trials (RCTs) enrolling 542 and 539 patients who underwent TRA and TFA cerebral angiography, respectively. Comparable pooled successful puncture rates (p = 0.05), successful cerebral angiography rates (p = 1.00), and operative duration (p = 0.10) were observed when comparing these two groups of patients. Relative to the TFA, the TRA was associated with a significantly reduced puncture time (p < 0.00001), a decreased fluoroscopic duration (p < 0.00001), lower rates of complications (p < 0.00001), and more rapid postoperative recovery (p < 0.00001). Significant heterogeneity was found when analyzing the puncture duration (I2 = 98%), operative duration (I2 = 97%), and fluoroscopic duration (I2 = 82%).

Conclusions
These results suggest that TRA and TFA cerebral angiography strategies can yield similar rates of successful cerebral angiography outcomes. However, complication rates are lower and postoperative recovery is more rapid for patients who undergo TRA cerebral angiography as compared to TFA cerebral angiography.