Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases

Abstract

ObjectiveTo compare transradial artery access (TRA) to the gold standard of transfemoral artery access (TFA) in mechanical thrombectomy (MT) for stroke caused by anterior circulation large vessel occlusion.MethodsThe clinical outcomes, procedural speed, angiographic efficacy and safety of both techniques were analysed in 375 consecutive cases over an 18-month period in a high volume statewide neurointerventional service.ResultsThere was no significant difference in patient characteristics, stroke parameters, imaging techniques or intracranial techniques. The median time elapsed between CT scanning and reperfusion was 96.5 min (IQR 68–123) in the TFA group and 95 min (IQR 68–123) in the TRA group (p=0.456). Of 336 patients who were independent at presentation 58% (124/214) of the TFA group and 67% (82/122) of the TRA group had a modified Rankin score of 0–2 at 90-day follow-up (p=0.093). Cross-over from radial to femoral was 4.6% (4/130) compared with 1.6% cross-over from femoral to radial (4/245), but did not meet the predetermined level of statistical significance (OR 2.92, 95% CI 0.81 to 10.52), p=0.088) and did not impact median procedural speed. Adequate angiographic reperfusion, first pass reperfusion, embolisation to new territory and symptomatic intracranial haemorrhage were similar in both groups. There was a significant difference in major access site complications requiring an additional procedure. None of the TRA cases had a major access site complication but 6.5% (16/245) of the TFA cases did (p=0.003).ConclusionThis study suggests that using TRA for anterior circulation MT is fast, efficacious, safe and not inferior to the gold standard of TFA.

Radial first or patient first: a case series and meta-analysis of transradial versus transfemoral access for acute ischemic stroke intervention

“…There were two (0.67%) reported access-site complications among the transradial group, whereas there were 27 (5.8%) in the transfemoral group. The frequency of symptomatic ICH reported in three studies [13][14][15] and our case series was 4.78% in the transradial group and 8.06% in the transfemoral group. Successful reperfusion was achieved in 88.8% of the transradial group and 93.2% of the transfemoral…”

“…Phillips et al reported 3-month mRS scores of 0-2 for only those TRA and TFA groups of patients who had premorbid mRS scores of 0-2. 15 Therefore, functional outcomes were not reported for eight patients in the TRA group and 31 patients in the TFA group. Due to the lack of complete data, a pooled analysis was not possible.…”

“…Previous studies have claimed little difference in the angiographic and clinical outcomes of TRA and TFA for MT. 8 13-15 With the exception of the study conducted by Philips et al, 15 previous studies on radial stroke intervention are small in size, do not have a direct comparison with a transfemoral cohort, and, more importantly, do not report 3-month mortality and outcomes because they focus on feasibility and safety. Moreover, little consideration was given to technical details and their influence on the associated angiographic outcomes.…”

Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions

“…It suggests that using TRA for anterior circulation MT may be fast, effective, safe and not inferior to the TFA. 83 However, there are several limitations of TRA: (1) it may not use a larger diameter of neurointerventional access catheter or a BGC; (2) difficulty to navigate through sharp turns or anatomy, that is, the acute angle between the carotid artery and subclavian artery in the aortic arch, the occlusion of the subclavian artery and varies types of aortic arch; and (3) require addition training.…”

Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center

“…The median (IQR) catheterization time was 10 (8-16) min in the direct TRA group and 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) in the direct TFA group (P < 0.001) (Fig. 3A).…”