Article Text
Abstract
Introduction Transradial access is increasingly common in cerebrovascular intervention, but its safety and efficacy in mechanical thrombectomy (MT) in acute ischemic stroke remain unclear. We present a single-institution experience at a high-volume comprehensive stroke center comparing neurologic outcomes between transfemoral and transradial MT procedures.
Materials and Methods We reviewed a prospectively maintained single-institution stroke database including consecutive cases between January 1, 2016 and December 31, 2023. Inclusion criteria were: Age >18 years and presentation within 24 hours of last-known-well. Patients were categorized by initial access site (transradial or transfemoral). For anterior circulation occlusions, a propensity matched cohort for access site was created using age and time from symptom onset to arterial access, with exact matching for occlusion site and thrombolytic administration. Multivariate regressions for puncture-to-deployment of first device and puncture-to-recanalization times, radiographic outcomes, binarized discharge, and 90-day modified Rankin score were calculated. An interaction model was calculated for laterality and access site.
Results 1648 patients were included (1381 transfemoral, 267 transradial). The transradial group had fewer females (42.7% vs. 52.1%, p=0.005), lower NIHSS (15.1±7.1 vs. 16.4±7.1, p=0.002), more posterior circulation occlusions (13.1% vs. 3.8%, p=0.01), and greater median onset-to-puncture interval (360 [IQR73–656] vs. 254 [IQR 169–624] min, p=0.02). Intubation (6.9% overall) and intravenous TPA administration (39.2%) rates were similar between groups. Transradial procedures had longer puncture-to-device-deployment and -recanalization intervals (22 [IQR 10.0–19.0] vs. 13 [IQR10–19] min, 29 [IQR15.5–28] vs. 20 [IQR 14–31] min) for all occlusion sites, but among posterior circulation occlusions, there was no difference in puncture-to-recanalization interval (20 [IQR 15–31] min). Access site crossover was more common in the transradial group (6.7% vs. 0.7%, p < 0.001). Transradial procedures had a higher rate of TICI 3 reperfusion (49.8% vs. 41.6%) but not TICI 2c/3 (66.7% overall) with similar rates of embolization to new territories (1.5% vs. 3.8%, p = 0.056). Proportions of favorable neurological outcomes were not different at discharge or 90 days. The matched cohort included 206 transradial and 206 transfemoral cases. In multivariate modelling transradial access was associated with increased puncture-to-deployment and puncture-to-recanalization times (8.6 [95%CI 6.1–11.7] min, 8.2 [95%CI 4.2–12.1] min). There was no interaction with laterality. Access site choice was not associated with neurological outcome, successful reperfusion, or embolization to new territory.
Conclusion Transradial MT was associated with similar posterior circulation but slower anterior circulation procedural times, overall similar rates of TICI 2c/3 reperfusion and similar neurologic outcomes when compared against transfemoral procedures.
Disclosures J. Feler: None. R. Torabi: None. C. Chang: None. C. Porto: None. M. Jayaraman: None. D. Wolman: None. K. Moldovan: None.