Transradial versus transfemoral access in middle meningeal artery embolization for chronic subdural hematoma: A systematic review and meta-analysis.

Background: Chronic subdural hematoma (cSDH) is increasingly prevalent in the elderly and traditionally treated with surgical interventions. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive therapy to reduce recurrence rates. Transfemoral access (TFA) is the conventional route for neuroendovascular procedures, but transradial access (TRA) offers potential advantages, including reduced access-site complications, earlier ambulation, and shorter hospital stays.

Objective: The aim of this systematic review and meta-analysis was to compare the safety and efficacy of TRA versus TFA for MMAE in cSDH patients.

Methods: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and involved a comprehensive search of four databases to identify studies comparing TRA and TFA in MMAE. Outcomes included hematoma recurrence, hospital length of stay, procedural duration, access-site complications, and overall complications.

Results: Four studies met the inclusion criteria. There were no significant differences between TRA and TFA in hematoma recurrence (Relative Risk (RR) 0.65, 95 % Confidence Interval [CI] 0.09-4.85), hospital length of stay (Mean Difference [MD] 0.10 days, 95 % CI -0.11-0.31), procedural duration (MD 0.04 h, 95 % CI -0.49-0.56), access-site complications (RR 0.24, 95 % CI 0.04-1.40), or overall complications (RR 0.76, 95 % CI 0.33-1.75).

Conclusions: TRA demonstrates comparable safety and efficacy to TFA for MMAE in cSDH patients. Although current evidence is limited to observational studies, these findings support the feasibility of TRA as an access route. Future large-scale studies are necessary to validate these results and optimize procedural strategies.