Transradial versus transfemoral access for mechanical thrombectomy in acute ischemic stroke: A retrospective cohort study

医学 溶栓 冲程(发动机) 队列 回顾性队列研究 闭塞 导管 内科学 外科 心肌梗塞 机械工程 工程类
作者
Leonard H. Verhey,Andres Restrepo Orozco,Marion Oliver,Leah Lyons,Andrea P. Sewell,Jenny P-C Tsai,Paul Mazaris,Muhib Khan,Justin Singer
出处
期刊:Journal of stroke and cerebrovascular diseases [Elsevier BV]
卷期号:32 (10): 107282-107282 被引量:5
标识
DOI:10.1016/j.jstrokecerebrovasdis.2023.107282
摘要

The objective of this study was to compare procedural and clinical outcomes in patients with acute ischemic stroke (AIS) treated via transradial access (TRA) mechanical thrombectomy (MT) versus conventional transfemoral access (TFA).We performed a retrospective analysis of consecutive patients with AIS treated with TRA versus TFA MT at our tertiary comprehensive stroke center. Access choice was individualized based on occlusion site, aortic and arch anatomy. Outcomes were extracted from our institutional stroke registry and included procedural time, Thrombolysis in Cerebral Infarction (TICI) reperfusion score, NIHSS, 90-day mRS and 90-day mortality. Comparisons were performed using Student t-Test and Fischer's exact test as appropriate.175 mechanical thrombectomies were performed during the study interval; 39 (22%) were performed via TRA and 136 (79%) TFA. Access to reperfusion time was 36.3 ± 24.5 minutes in the TRA group and 21.9 ± 17.6 in the TFA group (p<0.001). The proportion of patients with a TICI reperfusion score of 2b or 3 was similar in both groups (TRA: 34 (87%) vs. TFA: 121 (89%) p=0.559. The median 90-day mRS was similar between both groups (p=0.170), as was the 90-day mortality (p = 0.509).While TFA is faster in our cohort, TFA and TRA are both safe and effective for MT in acute ischemic stroke. While TFA remains mainstay, TRA can be valuable in variant anatomy despite its technical limitations. Individualizing access based on advanced imaging and patient factors may improve practice; however, updates in catheter and access technology are necessary to optimize outcomes with TRA.
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