Introduction Tri-axial system (TAS) via trans-femoral access (TFA) is widely used for mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Quadri-axial system (QAS) via TFA has been rarely reported and not systematically described.

Aim of Study To demonstrate safety and effectiveness of QAS compared with TAS for MT.

Methods We retrospectively analyzed 321 consecutive patients who underwent MT for AIS at our Institution from August 2019 to December 2022. Patients were divided in two groups: TAS (using short 8F sheath) and QAS (using long 8F sheath). Puncture to recanalization time, number of passes for recanalization, mTICI score, technical failure due to aortic arch/vessel anatomy, complication rate were compared.

Results TAS was used in 179 patients and QAS in 142 patients. Mean procedure duration was 53.2 minutes in TAS and 43.64 minutes in QAS group. In TAS group procedure was completed in 96% (n=172) and abandoned in 1.67% (n=3) for challenging vascular anatomy. In QAS group procedure was completed in 99% (n=141); none was abandoned due to vascular anatomy. Favourable recanalization was reported in 62% (n=107) in TAS and in 81% (n=115) in QAS group. First pass recanalization was achieved in 42% (n=75) in TAS and 51% (n=75) in QAS group. Complication rate (4%) was similar in both groups.

Conclusion QAS via TFA for MT in AIS is a safe and effective technique, even in challenging cases, allowing faster and more successful procedures without increasing complications. QAS could redefine and widen the boundaries of TFA in AIS.

Disclosure of Interest Nothing to disclose.