Abstract TP44: Trans-Radial Approach in Mechanical Thrombectomy in Anterior Circulation Large Vessel Stroke; Two Center Experience

Abstract

Background: Trans-femoral access (TFA) is used conventionally for mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke. Trans-radial access (TRA) is not only an alternative access route when TFA is not successful but has been shown to significant advantages over TFA in cardiac interventions in large prospective studies. In LVO stroke also, TRA may have several advantages over TFA, including greater technical ease of selection of great vessels at the arch in Type 2 & 3 arches in older stroke patients, avoidance of aorto-illiac disease and less frequency of access complications. We assessed the technical feasibility and safety of TRA for MT in Anterior Circulation LVO in 2 large tertiary care hospitals. Methods: This is a retrospective two-center study of patients undergoing MT for anterior LVO via a TRA from January 2015 through June 2017. From the institutional database of patients receiving MT we identified consecutive patients in whom a TRA was performed for MT for anterior circulation Large vessel occlusion. A 6F guide sheath and 6F Guide-catheter system introduced through the radial artery with or without balloon at distal tip was used for the MT procedure with a standard microcatheter MT technique. We measured workflow metrics, complications and feasibility and safety in this cohort. Results: 27 out of 390 (6.9%) MT patients underwent TRA MT for anterior LVO during the study period. There were 8 males (29.6%) and 19 females (70%). There were 9 patients (33.3%) in whom a TFA was attempted initially and had to be converted to a TRA due to inability to catheterize the great vessels via TFA. In rest of the patients, TRA was the first line approach. The mean age of patients was 80 ±12, females 84.5±9.6 years, males 74.1±16.2 years. Median time from access to reperfusion was 60 minutes (IQR 37 to 94). 22 (81.4%) had excellent rates of revascularization (TICI 2b, 3). Symptomatic ICH was observed in 3 patients (11.1%). There were no access related complications were noted in any of the patients. Conclusion: TRA for MT in patients with anterior circulation LVOs is feasible, safe and achieves rapid reperfusion similar to TFA for MT. Apart from being an alternative when TFA is not feasible, it should be studied further as a first line approach for MT in LVO stroke.