Transradial Approach for Mechanical Thrombectomy of Posterior Circulation Stroke

Abstract

Objective: We report the mechanical thrombectomy (MT) of posterior circulation large vessel occlusion (pc-LVO) in which the transradial approach (TRA) was selected as an initial approach route to reduce the duration of treatment.Case Presentation: We performed MT using the TRA for four patients with pc-LVO between November 2015 and March 2017. The TRA was used as an initial approach route in patients in whom preoperative MRI showed that the right vertebral artery (VA) was predominant. In all patients, the procedure could be accomplished without changing the approach route. Thrombolysis in Cerebral Infarction (TICI) 2b or better recanalization was achieved in all patients (100%), and TICI 3 recanalization in three patients (75%). Mean time from radial artery puncture to initial intracranial angiography and to the effective recanalization was 7.3 ± 1.5 and 28.8 ± 6.2 minutes, respectively. There was no complication at the site of puncture. Conclusion:Recanalization was promptly and effectively achieved by the MT of pc-LVO using the TRA. The results suggest that TRA can be utilized as an initial access route in patients in whom an approach to the right VA is possible.

Mechanical Thrombectomy for Large Vessel Occlusion via the Transbrachial Approach: Case Series

“…In MT with acute ischemic stroke in the posterior circulation, it has been reported that the transradial approach could be used as the primary access in patients where the approach from the right vertebral artery is viable, based on prior magnetic resonance (MR) angiography [ 19 ].…”

“…In MT with acute ischemic stroke in the posterior circulation, it has been reported that the transradial approach could be used as the primary access in patients where the approach from the right vertebral artery is viable, based on prior magnetic resonance (MR) angiography. 19 In order to select cases in which the transbrachial approach could be the first choice in the future, it is necessary for elderly patients to routinely undergo MR angiography or 3D-CT angiography that includes the aortic arch. In addition, the transbrachial approach is impossible for patients with stenotic lesions in the subclavian artery; MR angiography or 3D-CT angiography including the subclavian artery is therefore useful for detecting this before surgery.…”

Availability of tracheal shift in the chest X-ray image as pre-treatment evaluation of mechanical thrombectomy

“…[1][2][3][4][5][6][7][8] However, various factors might cause difficulties in guiding catheter (GC) induction, including the aortic arch structure, arterial tortuosity or calcification, and atherosclerotic stenosis. [9][10][11][12][13][14][15][16][17][18][19][20] Previous studies have indicated that the interval between treatment initiation and final recanalization had positive correlation with GC induction and favorable prognosis. 3,[9][10][11][12][13][16][17][18][20][21][22][23] For better prognosis, prompt change in approach route is necessary when difficulties are encountered in GC induction through the right common femoral artery (CFA), the most easily accessible artery during MT.…”

“…[9][10][11][12][13][14][15][16][17][18][19][20] Previous studies have indicated that the interval between treatment initiation and final recanalization had positive correlation with GC induction and favorable prognosis. 3,[9][10][11][12][13][16][17][18][20][21][22][23] For better prognosis, prompt change in approach route is necessary when difficulties are encountered in GC induction through the right common femoral artery (CFA), the most easily accessible artery during MT. 10,14,[16][17][18]20 Since MT is an emergency procedure, it is necessary to decrease door-to-puncture time and minimize pre-treatment examination period for improving patient outcomes.…”

“…3,[9][10][11][12][13][16][17][18][20][21][22][23] For better prognosis, prompt change in approach route is necessary when difficulties are encountered in GC induction through the right common femoral artery (CFA), the most easily accessible artery during MT. 10,14,[16][17][18]20 Since MT is an emergency procedure, it is necessary to decrease door-to-puncture time and minimize pre-treatment examination period for improving patient outcomes. Accordingly, it is common to limit pre-treatment examination to intracranial or cervical magnetic resonance imaging (MRI).…”