The association of transradial access and transfemoral access with procedural outcomes in acute ischemic stroke patients receiving endovascular thrombectomy: A meta-analysis

Shaban, Shirin; Rastogi, Aarushi; Phuyal, Subash; Huasen, Bella; Haridas, Abilash; Zeleňák, Kamil; Iacobucci, Marta; Martínez‐Galdámez, Mario; Jabbour, Pascal; Bhaskar, Sonu

doi:10.1016/j.clineuro.2022.107209

Cited by 16 publications

(8 citation statements)

References 41 publications

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“…Other variables, such as length of surgery, sheath size, and access site, were not associated with hemoglobin change. Access site being insignificant in multivariate analysis was a surprising finding, as both coronary and cerebral angiography studies have shown increased access site complications and bleeding from femoral access compared to radial [21,22]. This may be due to our smaller sample size with an overall small number of complications.…”

Section: Discussionmentioning

confidence: 79%

Assessment of Blood Loss during Neuroendovascular Procedures

Goutnik,

Nguyen,

Fleeting

et al. 2024

JCM

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(1) Background: Neuroendovascular procedures have generally been considered to have minor or inconsequential blood loss. No study, however, has investigated this question. The purpose of this study is to quantify the blood loss associated with neuroendovascular procedures and identify predictors of blood loss, using hemoglobin change as a surrogate for blood loss. (2) Methods: A retrospective review of 200 consecutive endovascular procedures (diagnostic and therapeutic) at our institution from January 2020 to October 2020 was performed. Patients had to have pre- and post-operative hematocrit and hemoglobin levels recorded within 48 h of the procedure (with no intervening surgeries) for inclusion. (3) Results: The mean age of our cohort was 60.1 years and the male representation was 52.5%. The mean pre-operative hemoglobin/hematocrit was significantly lower among females compared to males (12.1/36.2 vs. 13.0/38.5, p = 0.003, p = 0.009). The mean hemoglobin decrease was 0.5 g/dL for diagnostic angiograms compared to 1.2 g/dL for endovascular interventions (p < 0.0001), and 1.0 g/dL for all procedures combined. In a multivariate linear regression analysis, pre-operative antiplatelet/anticoagulant use was associated with a statistically significant decrease in hemoglobin. (4) Conclusions: Our data support that blood loss from diagnostic angiograms is marginal. Blood loss in endovascular interventions, however, tends to be higher. Pre-operative blood antiplatelet/anticoagulant use and increasing age appear to increase bleeding risk and may require closer patient monitoring.

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Section: Discussionmentioning

confidence: 79%

Assessment of Blood Loss during Neuroendovascular Procedures

Goutnik,

Nguyen,

Fleeting

et al. 2024

JCM

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“…Nevertheless, it is reasonable to choose an optimal vascular access for EVT. For endovascular interventions in patients with acute coronary syndromes or ischemic stroke, the transradial approach has been shown to be a safe alternative to the transfemoral approach (28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for lower extremity deep vein thrombosis in acute stroke patients following endovascular thrombectomy: a retrospective cohort study

Han,

Yang,

Qian

et al. 2023

Front. Neurol.

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BackgroundDeep vein thrombosis (DVT) in lower extremities as a common complication of acute ischemic stroke (AIS) has long been studied. However, as the therapeutic options for AIS continue to advance, the pathogenic mechanisms behind DVT may change. Endovascular thrombectomy (EVT) has replaced intravenous thrombolysis and become the preferred treatment for AIS patients with large vessel occlusions. Therefore, it is important to update our understanding of DVT and its management. This study aimed to determine the prevalence and risk factors of DVT in AIS patients following EVT.MethodsIn this retrospective study, 245 AIS patients who had received EVT were recruited between January 2020 and December 2021. Within 10 days (median 4 days) of thrombectomy, DVT was diagnosed by ultrasonography. Demographic characteristics, clinical findings, and therapeutic procedures were compared between patients with and without DVT using univariate analysis. Cutoff points were defined for EVT time and plasma D-dimer concentration. Multivariable logistic regression was then used to determine the independent risk factors for DVT and evaluate their predictive power.ResultsThe prevalence of DVT in AIS patients after EVT was 27.3%. Multifactorial logistic regression analysis showed that age (OR 1.036, 95% CI 1.001–1.073; P = 0.045), female sex (OR 3.015, 95% CI 1.446–6.289; P = 0.003), lower limb muscle strength less than grade three (OR 7.015, 95% CI 1.887–26.080; P = 0.004), longer EVT time (OR 1.012, 95% CI 1.004–1.020; P = 0.003), and higher D-dimer levels (OR 1.350, 95% CI 1.150–1.585; P < 0.001) were independently associated with higher DVT risk in AIS patients following EVT. The cutoff points for operative time of EVT and plasma D-dimer were 65.5 min and 1.62 mg/L, respectively, above which the risk for DVT was dramatically increased with OR > 4 in AIS patients.ConclusionAIS patients are at increased risk of developing DVT following EVT particularly if they have undergone prolonged thrombectomy procedures and exhibit high plasma levels of D-dimers. However, the results of our study need to be validated by a multicenter prospective study with a larger population of stroke patients.

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“…Due to increased comfort, shorter hospital stay, and fewer bleeding complications at the puncture location, transradial artery access is increasingly being applied currently in the endovascular diagnosis and treatment of coronary heart diseases, as compared to transfemoral access (1)(2)(3)(4)(5)(6). For cerebral angiography and endovascular treatment of cerebrovascular diseases, the use of transradial access has also been on the rise (7)(8)(9)(10)(11). Successful endovascular treatment through transradial access depends on navigating a guiding catheter to the proper location with good support for endovascular management; however, not all patients have good arterial anatomy for a successful and smooth endovascular operation.…”

Section: Introductionmentioning

confidence: 99%

Transradial intra-aortic catheter looping in the angioplasty of severe intracranial symptomatic arteriosclerotic diseases

Xu,

Xia,

Cai

et al. 2023

Front. Neurol.

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PurposeThis study aims to investigate the effect and feasibility of intra-aortic catheter looping via transradial access in angioplasty for symptomatic intracranial severe (>70%) atherosclerotic stenosis or occlusion of large arteries (SISOLAs).Materials and methodsPatients with SISOLAs who underwent transradial endovascular angioplasty using the catheter looping technique in the ascending aorta were retrospectively enrolled. The clinical data and treatment outcomes were analyzed.ResultsFifteen patients aged 48–71 years were enrolled in this study. Left vertebrobasilar artery occlusion was present in 1 (6.7%) patient, severe left middle cerebral artery stenosis in 7 (46.7%) patients, severe left internal carotid artery (ICA) stenosis of the ophthalmic segment in 4 (26.7%) patients, severe left ICA stenosis of the cavernous segment in 2 (13.3%) patients, and severe right middle cerebral artery stenosis in 2 (13.3%) patients. The arterial stenosis ranged from 70 to 92% (mean 86%) before stenting. The looping of a guiding catheter in the ascending aorta via transradial access for angioplasty was successful in all patients (100%). The vertebral artery intracranial segment occlusion was successfully recanalized, while severe stenosis in the remaining 14 patients was successfully eliminated. After endovascular recanalization, the residual stenosis was reduced by 12–26% (median 18%). No puncture-related complications or surgical-related neurological complications occurred in these patients. In the follow-up angiography conducted on 10 (66.7%) patients after 6–25 months, no in-stent restenosis was detected.ConclusionIntra-aortic guiding catheter looping via transradial access for endovascular angioplasty of SISOLAs is technically safe, feasible, and effective, especially when the transfemoral artery approach is difficult or impossible to undertake.

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The association of transradial access and transfemoral access with procedural outcomes in acute ischemic stroke patients receiving endovascular thrombectomy: A meta-analysis

Cited by 16 publications

References 41 publications

Assessment of Blood Loss during Neuroendovascular Procedures

Assessment of Blood Loss during Neuroendovascular Procedures

Risk factors for lower extremity deep vein thrombosis in acute stroke patients following endovascular thrombectomy: a retrospective cohort study

Transradial intra-aortic catheter looping in the angioplasty of severe intracranial symptomatic arteriosclerotic diseases

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