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Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

To compare clinical outcomes and safety of transradial (TRA) versus transfemoral access (TFA) for endovascular mechanical thrombectomy in acute stroke patients.

Methods

Retrospective analysis of 832 consecutive patients with acute stroke undergoing interventional thrombectomy using TRA (n = 64) or TFA (n = 768).

Results

Direct TFA failures occurred in 36 patients, 18 of which underwent crossover TFA to TRA, while direct TRA failures occurred in 2 patients having both crossovers to TFA. Successful catheterization was achieved in 96.8% (62/64) and 95.3% (732/768) of patients undergoing direct TRA and direct TFA, respectively, without significant differences. The median (IQR) catheterization time was 10 (8–16) min in the direct TRA group and 15 (10–20) in the direct TFA group (P < 0.001). This difference was also significant in the subgroup of anterior circulation strokes and in patients younger and older than 80 years of age. The majority of procedures yielded thrombolysis in cerebral infarction grade 2b/2c/3 revascularization in patients undergoing direct TRA (88.5%) and direct TFA (90.8%), without statistically significant differences. The median (IQR) puncture to recanalization time was 37 (24–58) min for the direct TRA group and 42 (28–70) min for the direct TFA group. Significant differences in access site complications, symptomatic ICH, and mRS score 0–2 at 90 days between both TRA and TFA accesses were not found.

Conclusions

TRA is not inferior to TFA in the probability of catheterization, times of catheterization and revascularization, and other clinical outcomes for mechanical thrombectomy in acute stroke.

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Data availability

Study data are available from the corresponding author upon request.

Code availability

The software applied was R statistical program version 4.0.2 for Windows.

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Acknowledgements

The authors thank Marta Pulido, MD, for editing the manuscript and editorial assistance.

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, C/Feixa Llarga S/N, L’Hospitalet de Llobregat, 08017, Barcelona, Spain

    Roger Barranco-Pons, Isabel Rodríguez Caamaño & Oscar Sabino Chirife

  2. Service of Neurology, Hospital Universitari de Bellvitge, Fundació Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain

    Anna Nuñez Guillen, Helena Quesada & Pere Cardona

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  1. Roger Barranco-Pons
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  2. Isabel Rodríguez Caamaño
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  4. Oscar Sabino Chirife
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  5. Helena Quesada
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  6. Pere Cardona
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Contributions

R. Barranco-Pons: principal investigator, design, data collection, analysis, and drafting of the manuscript. I. Rodríguez Caamaño and O. Sabino Chirife: design, data collection, and review of the manuscript for intellectual content. A. Nuñez-Guillen, H. Quesada and P. Cardona: data collection and review of the manuscript for intellectual content. All authors have seen and approved the final draft.

Corresponding author

Correspondence to Roger Barranco-Pons.

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The study was approved by the Ethics Committee of Hospital Universitari de Bellvitge, Barcelona (Spain).

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Written informed consent was waived as data were collected from a retrospective review of electronic medical records.

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ESM 1

Figure 4. Differences between TRA and TFA in the revascularization time (cumulative incidence puncture to recanalization) in the overall study population (A) using propensity score matching analysis (B), in anterior circulation stroke patients (C), and in posterior circulation stroke patients (D) (PNG 1128 kb)

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Barranco-Pons, R., Caamaño, I.R., Guillen, A.N. et al. Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center. Neuroradiology 64, 999–1009 (2022). https://doi.org/10.1007/s00234-021-02850-4

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