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  • Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases

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Original research
Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases
  1. Timothy John Phillips1,2,
  2. Matthew Thomas Crockett1,3,
  3. Gregory D Selkirk1,3,
  4. Ruchi Kabra1,2,
  5. Albert Ho Yuen Chiu1,2,
  6. Tejinder Singh1,2,
  7. Constantine Phatouros1,3,
  8. William McAuliffe1,3
  1. 1 Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  2. 2 Neurological Intervention and Imaging Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia, Australia
  3. 3 Neurological Intervention and Imaging Service of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Timothy John Phillips; timothy.john.phillips{at}gmail.com

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.

  • stroke
  • intervention
  • thrombectomy
  • artery
  • technique

Data availability statement

Deidentified participant data may be available from the corresponding author on reasonable request, subject to permission from the local ethics board.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2020-000624

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    Data availability statement

    Deidentified participant data may be available from the corresponding author on reasonable request, subject to permission from the local ethics board.

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    Footnotes

    • Twitter @timbo_phillips

    • Contributors TJP planned the study, wrote the manuscript, and is responsible for the overall content. MTC and GDS contributed to data collection. RK, AHYC, TS, CP and WM provided critical review of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests TJP has consultancy agreements with Merit Medical, Stryker Neurovascular, Medtronic, and Microvention. AHYC has a consultancy agreement with Stryker Neurovascular.

    • Provenance and peer review Not commissioned; externally peer reviewed.