Transradial versus transfemoral access for intracranial aneurysm treatment: evidence from a systematic review and meta-analysis

Abstract Background Recent studies comparing transradial (TRA) and transfemoral access (TFA) in endovascular treatment of intracranial aneurysms have yielded inconclusive results. Due to its superficial course and fewer access-site complications, TRA may provide improved safety and efficacy. This study directly compares TRA and TFA for safety and effectiveness in treating intracranial aneurysms. Methods We systematically searched PubMed, Embase and Cochrane for clinical studies comparing TRA and TFA in endovascular treatment of intracranial aneurysms, including studies published through October 15, 2025. A random-effects meta-analysis was performed following PRISMA. Interstudy heterogeneity was assessed using I² and X² statistics (I²>50%=significant heterogeneity). Results Seven studies involving 3,754 patients receiving TRA (444) or TFA (3,310) were included (age range: 52–68 years). Compared to TFA-treated patients, TRA-treated patients demonstrated significantly lower rates of access-site complications (risk ratio, 0.28; 95% CI, 0.12–0.65; p = 0.003), without an increased risk of intracranial hemorrhage (1.10; 0.53–2.30; p = 0.60) or stroke (0.86; 0.19–4.01; p = 0.85). TRA-treated patients showed similar rates of complete aneurysm occlusion (1.06, 0.87–1.27, p = 0.59) and all-cause mortality (0.89, 0.34–2.37, p = 0.82), but shorter procedure duration (− 13.59 min, − 18.89 to − 8.28, p < 0.00001) and reduced hospital stay (− 1.26 days, − 2.50 to − 0.02, p = 0.05). Conclusion TRA is superior to TFA in reducing access-site complications and is associated with shorter procedure duration and hospital stay without affecting aneurysm occlusion, intracranial hemorrhage, stroke, or mortality.