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Original research
Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes
  1. Stephanie H Chen1,
  2. Brian M Snelling2,
  3. Samir Sur1,
  4. Sumedh Subodh Shah1,
  5. David J McCarthy1,
  6. Evan Luther1,
  7. Dileep R Yavagal1,3,
  8. Eric C Peterson1,
  9. Robert M Starke1,4
  1. 1 Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  2. 2 Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, Florida, USA
  3. 3 Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
  4. 4 Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Robert M Starke, Department of Neurological Surgery and Radiology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA; RStarke{at}med.miami.edu

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.

  • technique
  • stroke
  • intervention
  • artery
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Footnotes

  • Contributors All authors contributed to the conception, data collection, and drafting of this manuscript. RMS statistically analyzed the data. DRY, ECP, and RMS provided manuscript oversight and administrative support. All authors critically reviewed the manuscript and approved its final submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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