Transition to transradial access for mechanical thrombectomy—lessons learned and comparison to transfemoral access in a single-center case series

Abstract

BACKGROUND: Trends in mechanical thrombectomy have emphasized larger bore aspiration catheters that may be difficult to deploy from a radial access point due to size constraints or need to obtain sheathless access. As such, many neurointerventionists are reticent to attempt thrombectomy through transradial access (TRA) for fear of worse outcomes. OBJECTIVE: To explore whether mechanical thrombectomy could be achieved safely and effectively through the transradial route. METHODS: We retrospectively analyzed the records of patients undergoing mechanical thrombectomy at our academic institute between January 2018 and January 2019, which corresponded to a time when we began to transition to TRA for neurointerventions, including mechanical thrombectomy. We compared the procedural details and clinical outcomes of patients undergoing mechanical thrombectomy using TRA with those using transfemoral access (TFA). RESULTS: During the study period, 44 patients underwent mechanical thrombectomy with TRA and 129 with TFA. There was no statistically significant difference in door-to-access time, door-to-reperfusion time, or first-pass recanalization rate. There was no significant difference in modified Rankin Scale (mRS) score at discharge, mRS score at last follow-up, or length of stay. There were 7 access-site complications in the TFA group and none in the TRA group. One patient in the TRA group required crossover to TFA. CONCLUSION: Mechanical thrombectomy can be performed safely and effectively from a TRA site without compromising recanalization times or rates. TRA has superior access-site complication profiles compared to TFA.