Transradial versus transfemoral access in diagnostic cerebral angiography: a comprehensive systematic review and meta-analysis of clinical outcomes and complications

Background Diagnostic Cerebral Angiography (CA) is a relatively common procedure that provides detailed evaluation of the brain's blood vessels. With the growing preference for Transradial artery (TRA) access over Transfemoral artery (TFA) access, our review aims to compare clinical outcomes and complications between these two approaches. Methods We carried out a systematic review using PubMed, Embase, Web of Science, Scopus databases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Inclusion was limited to studies that exclusively compared TRA versus TFA approaches for cerebral diagnostic purposes. Results Our study included 27 studies encompassing a total of 12,806 patients. The TRA arm comprised 6,284 patients with a median age of 57.9 years, and 46.4% were male. The TFA arm included 6,522 patients with a median age of 59.0 years, and 44.8% were male. Our analysis revealed that the TFA group had a higher successful Cerebral Angiography (CA) rate (OR = 0.62, p = 0.03), and lower crossover rate (OR: 2.85, p < 0.01) compared to the TRA group. However, the TRA group demonstrated a significantly lower rate of total complications (OR: 0.52, p < 0.01) and shorter hospital length of stay (LOS) in hours ([MD]: -33.25, p < 0.001) compared to the TFA group. There were no significant differences between groups in terms of procedural metrics. Conclusion Our review highlighted the superiority of the transfemoral artery approach in terms of success rates and lower crossover rates. However, transradial artery access may be preferred due to its association with lower complication rates and shorter hospital stays, aligning with patient-centered outcomes.