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J Neurointerv Surg. 2019 Sep;11(9):874-878. doi: 10.1136/neurintsurg-2018-014485. Epub 2019 Jan 22.

Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes.

Author information

1
Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
2
Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, Florida, USA.
3
Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
4
Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA.

Abstract

BACKGROUND:

A transradial approach (TRA) is associated with fewer access site complications than a transfemoral technique (TFA).However, there is concern that performing mechanical thrombectomy (MT) via TRA may lead to longer revascularization times and thus worse outcomes. Nonetheless, TRA may confer added benefits in MT since navigation of challenging aortic arch and carotid anatomy is often facilitated by a right radial artery trajectory.

OBJECTIVE:

To compare outcomes in patients who underwent MT via TRA versus TFA.

METHODS:

We performed a retrospective review of our institutional database to identify 51 patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion between February 2015 and February 2018. Patient characteristics, procedural techniques, and outcomes were recorded. TFA and TRA cohorts were compared.

RESULTS:

Of the 51 patients, 18 (35%) underwent MT via TRA. There were no significant cohort differences in patient characteristics, clot location, or aortic arch type and presence of carotid tortuosity. There were no significant differences in outcomes between the two cohorts, including single-pass recanalization rate (54.5% vs 55.6%, p=0.949) and average number of passes (1.9 vs 1.7, p=0.453). Mean access-to-reperfusion time (61.9 vs 61.1 min, p=0.920), successful revascularization rates (Thrombolysis in Cerebral Infarction score ≥2b 87.9% vs 88.9%, p=1.0) and functional outcomes (modified Rankin Scale score≤2, 39.4% vs 33.3%, p=0.669) were similar between TFA and TRA cohorts, respectively.

CONCLUSIONS:

Our results demonstrate equivalence in efficacy and efficiency between TRA and TFA for MT of anterior circulation large vessel occlusion in patients with challenging vascular anatomy. TRA may be better than TFA in well-selected patients undergoing MT.

KEYWORDS:

artery; intervention; stroke; technique

PMID:
30670623
DOI:
10.1136/neurintsurg-2018-014485
[Indexed for MEDLINE]

Conflict of interest statement

Competing interests: BS is a shareholder in RIST Neurovascular. ECP is a consultant for Medtronic Neurovascular, Stryker Neurovascular, Penumbra, and Cerenovus, and is a stockholder in RIST Neurovascular. RMS is a consultant for Medtronic Neurovascular, Penumbra, Cerenovus, and Abbott.

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