Crossover from Femoral to Radial Access During Mechanical Thrombectomy of Large Vessel Occlusion Stroke

Chen, Yimin; Sahoo, Anurag; Cai, Xiaodong; Mofatteh, Mohammad; Mian, Asim Z.; Lin, Hao; Yang, Shuiquan; Nguyen, Thanh N.; Abdalkader, Mohamad

doi:10.1016/j.wneu.2023.08.077

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Future multi-center randomized clinical trials powered to explore safety variables and 90-day functional outcomes are warranted. Some selection criteria based on clinical and radiological characteristics (such as posterior circulation or bovine arch and left-sided occlusion) 24 may enrich the sample to find those groups that can be benefited of TRA as first approach.…”

Section: Discussionmentioning

confidence: 99%

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Radial Versus Femoral Access for Mechanical Thrombectomy in Patients With Stroke: A Noninferiority Randomized Clinical Trial

Hernandez,

Requena,

Olivé-Gadea

et al. 2024

Stroke

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Background: Transfemoral access is predominantly used for mechanical thrombectomy in stroke patients with a large vessel occlusion. Following the interventional cardiology guidelines, routine transradial access has been proposed as an alternative, although its safety and efficacy remain controversial. We aim to explore the non-inferiority of radial access in terms of final recanalization. Methods: The study was an investigator-initiated, single-center, evaluator-blinded randomized clinical trial. Stroke patients undergoing mechanical thrombectomy, with a patent femoral artery and a radial artery diameter ≥2.5mm, were randomly assigned (1:1) to either transradial (60 patients) or transfemoral access (60 patients). The primary binary outcome was the successful recanalization (eTICI 2b-3) assigned by blinded evaluators. We established a non-inferiority margin of -13.2%, considering an acceptable reduction of 15% in the expected recanalization rates. Results: From September 2021 to July 2023, 120 patients were randomly assigned and 116 (58 transradial access, 58 transfemoral access) with confirmed intracranial occlusion on the initial angiogram were included in the intention-to-treat analysis. Successful recanalization was achieved in 51 (87.9%) patients assigned to transfemoral access and in 56/58 (96.6%) patients assigned to transradial (adjusted one side risk difference -5.0% (95% CI, -6.61% to +13.1%) showing non-inferiority of transradial access. Median time from angiosuite arrival to first pass (femoral: 30 (IQR 25-37) minutes versus radial: 41 (IQR 33-62) minutes, p<0.001) and from angiosuite arrival to recanalization (femoral: 42 (IQR 28-74) versus radial: 59.5 (IQR 44-81) minutes, p<0.050) were longer in the transradial access group. Both groups presented one severe access complication and there was no difference in the rate of access conversion: transradial 7 (12.1%) versus transfemoral 5 (8.6%) (p=0.751). Conclusion: Among patients who underwent mechanical thrombectomy, transradial access was non-inferior to transfemoral access in terms of final recanalization. Procedural delays may favor transfemoral access as the default firstline approach.

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Section: Discussionmentioning

confidence: 99%

“…Median time from arterial puncture to first pass (TRA, 24 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) minutes versus TFA, 20 (17-26) minutes; P=0.007) and from arterial puncture to recanalization (TRA, 44 (32-62) minutes versus TFA, 30 minutes; P=0.030) were longer using radial access.…”

Section: Pp Analysismentioning

confidence: 99%

Radial Versus Femoral Access for Mechanical Thrombectomy in Patients With Stroke: A Noninferiority Randomized Clinical Trial

Hernandez,

Requena,

Olivé-Gadea

et al. 2024

Stroke

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“…We previously demonstrated that multiple factors, such as diabetes mellitus history, pre-stroke mRS, longer last known well-to-puncture time, and the number of mechanical thrombectomy passes are the predictors of failure of early neurological improvement ( Lai et al, 2023 ). Furthermore, other issues, such as challenging arterial anatomy, may prevent successful and timely EVT, which can be resolved by crossover from femoral to radial access ( Chen et al, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

Sun,

Jou,

Nguyen

et al. 2023

Front. Neurosci.

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Background and objectivesEndovascular thrombectomy (EVT) improves long-term outcomes and decreases mortality in ischemic stroke patients. However, a significant proportion of patients do not benefit from EVT recanalization, a phenomenon known as futile recanalization or reperfusion without functional independence (RFI). In this study, we aim to identify the major stroke risk factors and patient characteristics associated with RFI.MethodsThis is a retrospective cohort study of 297 consecutive patients with ischemic stroke who received EVT at three academic stroke centers in China from March 2019 to March 2022. Patient age, sex, modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS), Alberta stroke program early CT score (ASPECTS), time to treatment, risk factors and comorbidities associated with cerebrovascular diseases were collected, and potential associations with futile recanalization were assessed. RFI was successful reperfusion defined as modified thrombolysis in cerebral infarction (mTICI) ≥ 2b without functional independence at 90 days (mRS ≥ 3).ResultsOf the 297 initial patients assessed, 231 were included in the final analyses after the application of the inclusion and exclusion criteria. Patients were divided by those who had RFI (n = 124) versus no RFI (n = 107). Older age (OR 1.041, 95% CI 1.004 to 1.073; p = 0.010), chronic kidney disease (OR 4.399, 0.904–21.412; p = 0.067), and higher 24-h NIHSS (OR 1.284, 1.201–1.373; p < 0.001) were independent predictors of RFI. Conversely, an mTICI score of 3 was associated with a reduced likelihood of RFI (OR 0.402, 0.178–0.909; p = 0.029).ConclusionIn conclusion, increased age, higher 24-h NIHSS and lack of an mTICI score of 3 were independently associated with RFI and have potential prognostic values in predicting patients that are less likely to respond to EVT recanalization therapy.

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Sex Differences in Outcomes after Endovascular Thrombectomy for Patients with Acute Ischemic Stroke

Chen,

Zeng,

Kwan

et al. 2024

Eur Neurol

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Introduction: Endovascular thrombectomy (EVT) is the standard of care for patients with large-vessel occlusion acute ischemic stroke (AIS). There may be differing recanalization effectiveness based on patients’ sex, and understanding such variations can improve patient outcomes by adjusting for differences. We aimed to assess the sex differences in outcome after EVT for patients with AIS. Methods: We retrospectively analyzed 250 consecutive AIS patients who underwent EVT from July 2019 to February 2022 across two large comprehensive tertiary care stroke centers in China. Outcomes of male patients were compared to females, where poor outcome was defined as a modified Rankin score (mRS) of 3-6 at 90 days. Results: Male patients had higher rates of symptomatic intracranial hemorrhage (sICH) (12.50% vs 4.05%, p = 0.042) and higher hospitalization costs (114541.08 vs. 105790.27 RMB, p = 0.024). Male patients also had a longer median onset-to-needle time (ONT) (146.00 (104.00, 202.00) vs. 120.00 (99.25, 144.75), p = 0.026). However, there were no differences in hospitalization length (p = 0.251), 90-day favorable outcome (p = 0.952), and 90-day mortality (p = 0.931) between the sexes. Conclusion: Female patients had lower hospitalization costs and sICH rates than males after EVT for AIS. Identifying such differences and implementing measures, including adaptations to workflow optimization, would help to reduce the ONT and last known normal-to-puncture-time seen in males to improve patient outcomes. Despite such variations, favorable outcomes and mortality are similar in female and male AIS patients.

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Crossover from Femoral to Radial Access During Mechanical Thrombectomy of Large Vessel Occlusion Stroke

Cited by 4 publications

References 14 publications

Radial Versus Femoral Access for Mechanical Thrombectomy in Patients With Stroke: A Noninferiority Randomized Clinical Trial

Radial Versus Femoral Access for Mechanical Thrombectomy in Patients With Stroke: A Noninferiority Randomized Clinical Trial

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

Sex Differences in Outcomes after Endovascular Thrombectomy for Patients with Acute Ischemic Stroke

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