TY - JOUR T1 - Commentary on ‘Radial first or patient first : a case series and meta-analysis of transradial (TRA) versus transfemoral (TFA) access for acute ischemic stroke intervention’ JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/neurintsurg-2021-017655 SP - neurintsurg-2021-017655 AU - Faheem G Sheriff AU - Gustavo J Rodriguez AU - Vikas Gupta AU - Alberto Maud Y1 - 2021/04/27 UR - http://jnis.bmj.com/content/early/2021/04/26/neurintsurg-2021-017655.abstract N2 - Dear Editor;We read with interest the manuscript entitled ‘Radial first or patient first: a case series and meta-analysis of transradial (TRA) versus transfemoral (TFA) access for acute ischemic stroke intervention’ by Siddiqui et al.1 We respect the authors on this important undertaking, but we would like to point out the following concerns in order to advance this new technique.‘Patient first’ should not lead to a general statement of ‘radial or femoral first approach’ in acute ischemic stroke intervention. Acute ischemic stroke intervention comprises a variety of different procedures with different technical demands. In their manuscript, there was lack of data on patient-specific anatomic features and other variables to allow identification of subgroups that might benefit from a particular access route. For instance, there was a paucity of posterior circulation strokes in the meta-analysis, with 88.9% being anterior circulation. We have previously shown significantly shorter skin puncture to reperfusion times … ER -