Trans-Carotid and Trans-Radial Access for Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

We aim to demonstrate the safety and effectiveness of extra-femoral endovascular access for mechanical thrombectomy for acute ischemic stroke patients whose vascular anatomy precludes safe or maneuverable trans-femoral access. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct a systematic review and meta-analysis with articles published until March 2018. The search protocol, including research questions and inclusion and exclusion criteria, were developed a priori. Our own institutional retrospective data were included in the cohort of case series. Results Eleven studies including 51 patients were included. Age ranged from 4th to 10th decade of life (average: 9.3rd decade) and 40.1% received IV tissue plasminogen activator. Initial National Institutes of Health Stroke Scale (NIHSS) score ranged from 1 to 36, (average: 17.6). Of the 51 patients, 39 (76%) patients suffered from anterior circulation large vessel occlusions versus 12 (24%) from posterior circulation occlusions. Site of access included 26 (51%) radial artery punctures, 23 (45%) direct percutaneous cervical carotid punctures, 1 brachial artery puncture, and 1 direct extradural vertebral artery puncture. Technical success was achieved in 43/51 (84%) of patients. The average modified Rankin Scale at discharge was 2.93 (n=26). There were no complications in 25 patients who underwent radial arterial access. Two (7.4%) of 27 cervical access patients developed hematoma.

Endovascular transmural access to carotid artery perivascular tissues: safety assessment of a novel technique

“…In modern times, direct percutaneous carotid puncture is used infrequently, but it can be used for neurointervention9 and cardiac intervention10 when alternate routes are unavailable or deemed higher risk. The risks of percutaneous transcarotid intervention have been studied in small case series,11–13 but they are generally not well known given the limited experience in the medical literature. Hybrid surgical-endovascular transcarotid procedures, the most well-known being transcarotid artery revascularization, has growing popularity and has been shown to be reasonably safe 14.…”

Safety and feasibility of transradial use of 8F balloon guide catheter Flowgate2 for endovascular thrombectomy in acute ischemic stroke

“…The most cited alternative in the last years for the anatomical challenging cases has been the transradial approach, however the use of BGC was limited to few reports. 9–12 In a report by Haussen et al., 10 TRA was attempted in 15 (1.5%) of 1001 patients, however the authors did not describe the use of BGC. Chen et al.…”

“…The transradial approach has become more popular in the neurointerventional field in the recent years, especially for diagnostic angiographies and aneurysm embolizations., However, there is a paucity of literature with the AIS experience. 9–12 Herein, we sought to evaluate the safety and feasibility of using the 8 F BGC Flowgate 2 transradially in patients with unfavorable anatomy (type 3 or bovine arch) during acute MT procedures.…”

Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry

“…In these situations, EVT through an alternative access route may be beneficial. Commonly used alternative approaches are through the radial, common carotid or brachial artery [11][12][13][14][15].…”

“…Interest is currently focused on radial access, as it is already widely used in coronary interventions. In the field of interventional cardiology, the radial approach is associated with lower complication rates and higher patient satisfaction than the femoral approach [13,16]. On the other hand, the small vessel diameter and the large amount of vascular anatomical variations may lead to a complex procedure, requiring specific experience of the interventionist [16,17].…”