PT  - JOURNAL ARTICLE
AU  - Muhammad Waqas
AU  - Andre Monteiro
AU  - Justin M Cappuzzo
AU  - Marissa D Kruk
AU  - Faisal Almayman
AU  - Steven B Housley
AU  - Jaims Lim
AU  - Rimal H Dossani
AU  - Kenneth V Snyder
AU  - Adnan H Siddiqui
AU  - Jason M Davies
AU  - Elad I Levy
TI  - Mechanical thrombectomy with a balloon-guide catheter: sheathless transradial versus transfemoral approach
AID  - 10.1136/jnis-2022-019607
DP  - 2022 Dec 29
TA  - Journal of NeuroInterventional Surgery
PG  - jnis-2022-019607
4099  - http://jnis.bmj.com/content/early/2022/12/28/jnis-2022-019607.short
4100  - http://jnis.bmj.com/content/early/2022/12/28/jnis-2022-019607.full
AB  - Background The transradial approach (TRA) for mechanical thrombectomy (MT) for acute ischemic stroke has been limited by the size of catheters usable in the radial artery, with the smaller access site precluding balloon-guide catheter (BGC) use. However, promising results have been reported for a TRA with a sheathless BGC (sTRA). We sought to perform a comparative study of MT with a BGC via the sTRA versus the transfemoral approach (TFA).Methods A retrospective review of our MT database was conducted. Baseline, procedure-related, and outcome data were compared for patients aged ≥18 years with anterior circulation large vessel occlusion, Alberta Stroke Program Early CT Score ≥6, and prestroke modified Rankin Scale score ≤2 treated with either approach.Results Ninety-three consecutive patients (34 sTRA and 59 TFA) were included. Both groups had similar demographics, comorbidities, stroke severity, intravenous alteplase use, and occlusion location. Mean time from puncture to final recanalization was faster in the sTRA group (29 vs 36 min, p=0.059) despite a higher access site crossover rate in the sTRA group (11.8% vs 0%, p=0.016). There were no differences between groups regarding last modified Thombolysis in Cerebral Infarction score; first-pass or modified first-pass effect; time from last known well to puncture; use of stent-retriever, aspiration, or combination first approach; number of passes; symptomatic intracranial hemorrhage; hospital stay; 90-day functional independence; and mortality. National Institutes of Health Scale score and modified first-pass effect were the only independent predictors of poor outcomes.Conclusions Comparable patients treated with MT via the sTRA or TFA had similar angiographic and clinical outcomes.