Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases
Timothy John Phillips, Matthew Thomas Crockett, Gregory D Selkirk, Ruchi Kabra, Albert Ho Yuen Chiu, Tejinder Singh, Constantine Phatouros, William McAuliffe, Timothy John Phillips, Matthew Thomas Crockett, Gregory D Selkirk, Ruchi Kabra, Albert Ho Yuen Chiu, Tejinder Singh, Constantine Phatouros, William McAuliffe
Abstract
Objective: To compare transradial artery access (TRA) to the gold standard of transfemoral artery access (TFA) in mechanical thrombectomy (MT) for stroke caused by anterior circulation large vessel occlusion.
Methods: The clinical outcomes, procedural speed, angiographic efficacy and safety of both techniques were analysed in 375 consecutive cases over an 18-month period in a high volume statewide neurointerventional service.
Results: There was no significant difference in patient characteristics, stroke parameters, imaging techniques or intracranial techniques. The median time elapsed between CT scanning and reperfusion was 96.5 min (IQR 68-123) in the TFA group and 95 min (IQR 68-123) in the TRA group (p=0.456). Of 336 patients who were independent at presentation 58% (124/214) of the TFA group and 67% (82/122) of the TRA group had a modified Rankin score of 0-2 at 90-day follow-up (p=0.093). Cross-over from radial to femoral was 4.6% (4/130) compared with 1.6% cross-over from femoral to radial (4/245), but did not meet the predetermined level of statistical significance (OR 2.92, 95% CI 0.81 to 10.52), p=0.088) and did not impact median procedural speed. Adequate angiographic reperfusion, first pass reperfusion, embolisation to new territory and symptomatic intracranial haemorrhage were similar in both groups. There was a significant difference in major access site complications requiring an additional procedure. None of the TRA cases had a major access site complication but 6.5% (16/245) of the TFA cases did (p=0.003).
Conclusion: This study suggests that using TRA for anterior circulation MT is fast, efficacious, safe and not inferior to the gold standard of TFA.
Keywords: artery; intervention; stroke; technique; thrombectomy.
Conflict of interest statement
Competing interests: TJP has consultancy agreements with Merit Medical, Stryker Neurovascular, Medtronic, and Microvention. AHYC has a consultancy agreement with Stryker Neurovascular.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
References
- Snelling BM, Sur S, Shah SS, et al. . Transradial approach for complex anterior and posterior circulation interventions: technical nuances and feasibility of using current devices. Oper Neurosurg 2019;17:293–302. 10.1093/ons/opy352
- Oselkin M, Satti SR, Sundararajan SH, et al. . Endovascular treatment for acute basilar thrombosis via a transradial approach: initial experience and future considerations. Interv Neuroradiol 2018;24:64–9. 10.1177/1591019917733709
- Chen SH, Snelling BM, Shah SS, et al. . Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study. J Neurointerv Surg 2019;11:796–800. 10.1136/neurintsurg-2018-014620
- Khanna O, Sweid A, Mouchtouris N, et al. . Radial artery catheterization for neuroendovascular procedures: clinical outcomes and patient satisfaction measures. Stroke 2019;50:2587–90.
- Brunet M-C, Chen SH, Sur S, et al. . Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography. J Neurointerv Surg 2019;11:710–3. 10.1136/neurintsurg-2019-014718
- Ferrante G, Rao SV, Jüni P, et al. . Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials. JACC Cardiovasc Interv 2016;9:1419–34. 10.1016/j.jcin.2016.04.014
- Saver JL, Goyal M, van der Lugt A, et al. . Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016;316:1279. 10.1001/jama.2016.13647
- Goyal M, Menon BK, van Zwam WH, et al. . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723–31. 10.1016/S0140-6736(16)00163-X
- Sur S, Snelling B, Khandelwal P, et al. . Transradial approach for mechanical thrombectomy in anterior circulation large-vessel occlusion. Neurosurg Focus 2017;42:E13. 10.3171/2017.1.FOCUS16525
- Khanna O, Mouchtouris N, Sweid A, et al. . Transradial approach for acute stroke intervention: technical procedure and clinical outcomes. Stroke Vasc Neurol 2020;5:103–6. 10.1136/svn-2019-000263
- Chen SH, Snelling BM, Sur S, et al. . Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes. J Neurointerv Surg 2019;11:874–8. 10.1136/neurintsurg-2018-014485
- Training guidelines for endovascular ischemic stroke intervention: an international multi-society consensus document. J Neurointerv Surg 2016;8:989–91. 10.1136/neurintsurg-2016-012316
- Snelling BM, Sur S, Shah SS, et al. . Transradial cerebral angiography: techniques and outcomes. J Neurointerv Surg 2018;10:874–81. 10.1136/neurintsurg-2017-013584
- Hahalis G, Aznaouridis K, Tsigkas G, et al. . Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTEry Occlusion Meta-AnalysIS) Systematic Review and Meta-Analysis. J Am Heart Assoc 2017;6. 10.1161/JAHA.116.005430. [Epub ahead of print: 23 Aug 2017].
Source: PubMed