RT Journal Article
SR Electronic
T1 Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 874
OP 878
DO 10.1136/neurintsurg-2018-014485
VO 11
IS 9
A1 Stephanie H Chen
A1 Brian M Snelling
A1 Samir Sur
A1 Sumedh Subodh Shah
A1 David J McCarthy
A1 Evan Luther
A1 Dileep R Yavagal
A1 Eric C Peterson
A1 Robert M Starke
YR 2019
UL http://jnis.bmj.com/content/11/9/874.abstract
AB 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.