Safety and efficacy of radial access versus femoral access for rotational atherectomy: an updated systematic review and meta-analysis

TL;DR

This study compares radial and femoral access for rotational atherectomy and finds radial access is safer with fewer bleeding risks and shorter hospital stays.

Contribution

The study provides updated evidence on the safety and efficacy of radial versus femoral access in rotational atherectomy.

Findings

Radial access significantly reduces major vascular site bleeding compared to femoral access.

Radial access is associated with lower MACE and shorter procedural time and hospital stay.

Other secondary outcomes showed no significant differences between the two access methods.

Abstract

Rotational atherectomy has been performed using both radial and femoral access over the years, but there is a lack of consensus on the safety and efficacy of these access sites.

PubMed, Google Scholar, and Cochrane Library were searched until May 2024 for studies comparing the radial and femoral approaches in patients undergoing rotational atherectomy. The primary outcome was major vascular site bleeding. Secondary outcomes included short-term mortality, long-term mortality, myocardial infarction, major adverse cardiovascular events (MACE), acute stent thrombosis, procedural success, procedural time, and hospital stay. Generic inverse variance (GIV) was used to pool the risk ratio for dichotomous outcomes and mean difference (MD) for the continuous outcomes, with corresponding 95% confidence intervals (CIs).

Twelve studies including 15,700 patients with a mean age of 77.77 years in the radial group and 74.04 years in the femoral group, who had undergone rotational atherectomy, were included in the analysis. For the outcome of major vascular site bleeding, there was a significantly lower risk (RR: 0.23; 95% CI [0.12, 0.41]; p < 0.00001) in the radial group as compared to the femoral group. From the secondary outcomes, radial access was found to have significantly lower MACE (RR:0.80; 95% CI [0.68, 0.93]; p = 0.004), shorter procedural time (MD: -6.95; 95% CI [-11.52, -2.38], p = 0.003) and hospital stay (MD: -2.8; 95% CI [-5.56, -0.04], p = 0.05) as compared to femoral group. In contrast, all the other secondary outcomes were found to be insignificant.

Rotational atherectomy using the radial approach has a significantly lower rate of major vascular site bleeding and MACE and is associated with significantly shorter procedural time and hospital stay.

The online version contains supplementary material available at 10.1186/s13019-025-03512-9.

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