Turkish Neurosurgery
Brachial Artery Access for Carotid Artery Stenting: A Pooled Analysis |
Marcelo Sousa Porto1, Sávio Batista1, Guilherme Melo Silva1, Márcio Yuri Ferreira3, Leonardo de Barros Oliveira2, José Victor Dantas dos Santos6, Raphael Muszkat Besborodco4, Filipi Fim Andreão1, Agostinho Camara Pinheiro5, Raphael Bertani7, José Alberto Almeida Filho8 |
1Faculty of Medicine, Federal University of Rio de Janeiro, Department of Neurosurgery, Rio de Janeiro/Rio de Janeiro, 2Faculty of Medicine, State University of Ponta Grossa, Department of Neurosurgery, Ponta Grossa/Paraná, 3Faculty of Medicine, Ninth July University, Department of Neurosurgery, São Paulo/São Paulo, 4Rusk Rehabilitation, NYU Langone Health, Department of Neurosurgery, New York/ New York, 5Massachusetts General Hospital, Brigham and Womens Hospital, Harvard Medical School, Department of Neurology, Boston/Massachusetts, 6Faculty of Medicine, Center University Estácio of Ceará, Iguatu Campus, Department of Neurosurgery, Iguatu/Ceará, 7University of São Paulo, Department of Neurosurgery, São Paulo/São Paulo, 8Municipal Hospital Miguel Couto, Department of Neurosurgery, Rio de Janeiro/Rio de Janeiro, |
DOI: 10.5137/1019-5149.JTN.46534-24.2 |
ABSTRACT
Introduction
In the realm of Carotid Artery Stenting (CAS), various access methods such as Transfemoral access (TFA), Transradial Artery access (TRA), and Transbrachial access (TBA) have been employed. While TFA is widely established, TRA and TBA offer alternative options. TBA lacks comprehensive studies, and there is a notable lack of comprehensive evidence systematically evaluating its outcomes.
Material and Methods
This systematic review and meta-analysis aimed to comprehensively evaluate the safety and efficacy of TBA for CAS by conducting a thorough search on Medline, Cochrane Library, Embase, and Web of Science databases. Studies reporting TBA for CAS and evaluating primary outcomes such as good neurological results, procedural success, and complications were included. Studies with fewer than 4 patients were excluded.
Results
After a meticulous selection of 1837 literature articles, 11 studies were meticulously chosen for the comprehensive examination, involving a total of 273 patients. The analysis of nine studies revealed a consistent 100% procedural success rate with minimal variability (95% CI: 98% to 100%). In the final assessment of neurological status across eight studies, good neurological outcomes were observed in 99% (95% CI: 98% to 100%). Additionally, nineteen complications were identified, leading to a 1% rate (95% CI: 0% to 9%). Among the 223 patients in eight studies, resulting in a pooled estimate of 0% mortality (95% CI: 0% to 1%), indicating a favorable safety profile.
Conclusion
The results of TBA for CAS demonstrate a highly effective and safe procedure. Despite the limitations, TBA can be an option in patients with no other access available, and further comparative studies are required to establish definitive conclusions.
Key-words: Brachial, Carotid, Carotid artery stenting, Stent, Transbrachial.
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Corresponding author : José Victor Dantas dos Santos