A comparison of radial versus femoral artery access for acute stroke interventions

Khanna, Omaditya; Velagapudi, Lohit; Das, Somnath; Sweid, Ahmad; Mouchtouris, Nikolaos; Saiegh, Fadi Al; Avery, Michael B; Chalouhi, Nohra; Schmidt, Richard F.; Sajja, Kalyan; Gooch, M. Reid; Tjoumakaris, Stavropoula; Rosenwasser, Robert H.

doi:10.3171/2020.7.jns201174

Cited by 18 publications

(20 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In conclusion, the present findings indicate that TRA is not inferior to TFA in the probability and times of catheterization and revascularization as well as other clinical outcomes for mechanical thrombectomy in acute stroke. Our data confirm the feasibility and effectiveness of the TRA in thrombectomy for acute stroke with similar outcomes compared with TFA, as recently reported in other series [47]. With increasing experience using TRA, this approach can be used as the first option, as an alternative in difficult anatomies on CTA, and as a second option, but it is recommended to have passed the learning curve and to avoid the humeral access associated with a higher rate of complications.…”

Section: Discussionsupporting

confidence: 88%

Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center

et al. 2021

View full text Add to dashboard Cite

Purpose To compare clinical outcomes and safety of transradial (TRA) versus transfemoral access (TFA) for endovascular mechanical thrombectomy in acute stroke patients. Methods Retrospective analysis of 832 consecutive patients with acute stroke undergoing interventional thrombectomy using TRA (n = 64) or TFA (n = 768). Results Direct TFA failures occurred in 36 patients, 18 of which underwent crossover TFA to TRA, while direct TRA failures occurred in 2 patients having both crossovers to TFA. Successful catheterization was achieved in 96.8% (62/64) and 95.3% (732/768) of patients undergoing direct TRA and direct TFA, respectively, without significant differences. The median (IQR) catheterization time was 10 (8-16) min in the direct TRA group and 15 (10-20) in the direct TFA group (P < 0.001). This difference was also significant in the subgroup of anterior circulation strokes and in patients younger and older than 80 years of age. The majority of procedures yielded thrombolysis in cerebral infarction grade 2b/2c/3 revascularization in patients undergoing direct TRA (88.5%) and direct TFA (90.8%), without statistically significant differences. The median (IQR) puncture to recanalization time was 37 (24-58) min for the direct TRA group and 42 (28-70) min for the direct TFA group. Significant differences in access site complications, symptomatic ICH, and mRS score 0-2 at 90 days between both TRA and TFA accesses were not found. Conclusions TRA is not inferior to TFA in the probability of catheterization, times of catheterization and revascularization, and other clinical outcomes for mechanical thrombectomy in acute stroke.

show abstract

Section: Discussionsupporting

confidence: 88%

Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center

et al. 2021

View full text Add to dashboard Cite

show abstract

“…There were two (0.67%) reported access-site complications among the transradial group, whereas there were 27 (5.8%) in the transfemoral group. The frequency of symptomatic ICH reported in three studies [13][14][15] and our case series was 4.78% in the transradial group and 8.06% in the transfemoral group. Successful reperfusion was achieved in 88.8% of the transradial group and 93.2% of the transfemoral…”

Section: Transradial Versus Transfemoral Analysissupporting

confidence: 41%

“…Most patients were treated for an anterior large vessel occlusion (90.4% of the transradial group, 95.1% of the transfemoral group). In addition to our case series, only Khanna et al 14 presented the frequency of each thrombectomy technique. Only two studies reported on the use of BGCs.…”

Section: Transradial Versus Transfemoral Analysismentioning

confidence: 91%

Radial first or patient first: a case series and meta-analysis of transradial versus transfemoral access for acute ischemic stroke intervention

Siddiqui

Waqas

Neumaier

et al. 2021

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundFew studies have compared technical success and effectiveness of transradial access (TRA) versus transfemoral access (TFA) for mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We compared the two approaches for technical success, effectiveness, and outcomes.MethodsWe retrospectively compared TRA with TFA for AIS MT at our institute. We additionally performed a systematic review and meta-analysis of studies describing the use of TRA alone or in comparison with TFA for MT. Primary outcomes included rate of successful reperfusion (thrombolysis in cerebral infarction (TICI) >2b), number of passes, access-site complications, and 3- month mortality and favorable functional outcomes (modified Rankin Scale (mRS) score 0–2).ResultsA total of 222 consecutive patients (TRA=93, TFA=129) were included in our case series. The rate of successful reperfusion was significantly higher for the TFA cohort (91.4% vs 79.6%, P=0.01) with lower mean number of passes (1.8±1.2 vs 2.4±1.6, P=0.014). Three-month mortality in the TFA group was lower (22.1% vs 40.9% for the TRA cohort (P=0.004), with a higher rate of favorable functional outcomes (51.3% vs 34.1%, P=0.015). A meta-analysis of 10 studies showed significant heterogeneity in rates of successful reperfusion (57.1% to 95.6%, heterogeneity=67.55%, P=0.001). None of the previous comparative studies reported 3-month mortality and functional outcomes.ConclusionsThis case series demonstrate a higher successful reperfusion rate, fewer passes, lower 3-month mortality, and improved 3-month functional outcomes with TFA. The systematic review highlights the inadequacy of existing evidence. Prospective comparative studies are needed before a ‘radial-first’ approach can be adopted for stroke intervention.

show abstract

“… 31 In both approaches, similar vascular characteristics are associated with revascularization success and increased procedural duration. 32 In addition, patients with specific characteristics, especially difficult arch anatomy, might be better treated with a transradial approach, 33 , 34 but this requires further research.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

Holswilder

Stuart

Dompeling

et al. 2022

European Stroke Journal

View full text Add to dashboard Cite

Introduction Vascular anatomy might affect endovascular treatment success in acute ischemic stroke patients with large vessel occlusion. We investigated the prognostic value of extracranial vascular characteristics on procedural time and revascularization success in patients with large vessel occlusion in the anterior cerebral circulation. Patients and methods We included 828 patients endovascularly treated within 6.5 hours of symptom onset from the Dutch MR CLEAN-Registry. We evaluated aortic arch configuration, stenosis and tortuosity of supra-aortic arteries, and internal carotid arteries (ICAs) on pre-intervention CTA. We constructed logistic prediction models for outcome variables procedural duration (≥60 minutes) and non-successful revascularization (extended thrombolysis in cerebral infarction (eTICI) of 0–2A) using baseline characteristics and assessed the effect of extracranial vascular characteristics on model performance. Results Cervical ICA tortuosity and stenosis ≥99% improved prediction of long procedural duration compared with baseline characteristics from area under the curve of 0.61 (95% CI: 0.57–0.65) to 0.66 (95% CI: 0.62–0.70) ( P < 0.001). Cervical ICA tortuosity was significantly associated with non-successful recanalization. Prediction of non-successful revascularization did not improve after including aortic arch elongation, acute take-off angle, aortic variant, origin stenosis of supra-aortic arteries, and cervical ICA tortuosity, with an area under the curve of 0.63 (95% CI: 0.59–0.67) compared with 0.59 (95% CI: 0.55–0.63) ( P = 0.11). Conclusion Extracranial vascular characteristics have additional prognostic value for procedural duration, but not for revascularization success, compared with baseline characteristics. Performance of both prediction models is limited in patients treated for large vessel occlusion.

show abstract

A comparison of radial versus femoral artery access for acute stroke interventions

Cited by 18 publications

References 17 publications

Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center

Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center

Radial first or patient first: a case series and meta-analysis of transradial versus transfemoral access for acute ischemic stroke intervention

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

Contact Info

Product

Resources

About