Transradial approach for acute stroke intervention: technical procedure and clinical outcomes

Abstract

Background and purpose: Radial artery catheterisation is an alternate route of access that has recently started to gain more widespread use for neuroendovascular procedures, including acute stroke intervention. In this small case series, we present our institution's outcomes in patients undergoing acute stroke interventions via transradial access.

Materials and methods: We present a retrospective study of 15 patients who underwent acute stroke intervention via radial artery access. We analyse these patients' periprocedural and clinical outcomes after undergoing mechanical thrombectomy.

Results: A total of 15 consecutive patients were included in the study (9 males and 6 females), and all patients were able to successfully undergo mechanical thrombectomy via radial artery access. The mean time of arterial puncture to reperfusion was 50±28 min (range: 15-104). A TICI 2b/3 revascularisation was achieved in 13/15 patients (87%); a TICI 1 and TICI 2a outcome was achieved on the other two patients. One patient incurred an iatrogenic vessel dissection during the procedure. Eight of out 15 patients (53%) had favourable mRS (0-3) at the time of discharge from the hospital.

Conclusion: Radial artery catheterisation is technically feasible for performing acute stroke interventions with favourable time to revascularisation and good overall clinical outcomes.

Keywords: angiography; stroke; technique; thrombectomy.

Conflict of interest statement

Competing interests: PJ is a consultant for Medtronic and MicroVention. ST is a consultant for Stryker.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Radial artery access is achieved via ultrasound guidance, using a counter-puncture technique, and a fluoroscopic image is taken to delineate arterial anatomy of the right arm (A). Using transradial access, all vessels of the aortic arch, with various configurations, are able to be catheterized safely and effectively, en route to the desired intracranial vasculature (B). A compression device is applied to the wrist at the conclusion of the procedure for 1 hour, and is gradually deflated as haemostasis is achieved (C).

Figure 2

When excluding two patients who were deceased (both made comfort care per family discussion), patients who survived their hospitalisation stay had significantly improved NIHSS post-op (mean 5.31±4.09) compared with at the time of presentation (mean 13.3±7.3) (A). The mRS scores of n=15 patients at the time of discharge from the hospital after undergoing transradial mechanical thrombectomy for acute stroke (B). NIHSS, NIH stroke scale.