Evolution of Transradial Access for Mechanical Thrombectomy—A Single Center Experience. Issue 4 (5th April 2023)

• Record Type: Journal Article
• Authors: Munich, Stephan A.; Saganty, Ruth S.; Joshi, Krishna C.; Radaideh, Yazan
• Is Part Of: Neurosurgery. Volume 92:Issue 4(2023)
• Page Start: 795
• Page End: 802
• Publication Date: 2023-04-05
• Subjects: Access -- Endovascular -- Mechanical thrombectomy -- Stroke; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/neu.0000000000002271
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: Transradial access (TRA) recently has gained popularity among neurointerventionalists. However, hesitation to its use for mechanical thrombectomy (MT) remains. OBJECTIVE: To evaluate and describe the evolution of TRA for MT. METHODS: We performed a retrospective analysis of patients undergoing TRA for MT. We performed a chronological ternary analysis to assess the impact of experience. We assessed the impact of a guide catheter designed specifically for TRA. RESULTS: We identified 53 patients who underwent TRA for MT. There was a statistically significant decrease in contrast use (148.9 vs 109.3 vs 115.2 cc), procedure time (62.4 vs 44.7 vs 41.3 minutes), fluoroscopy time (39.2 vs 44.7 vs 41.3 minutes), and puncture-to-recanalization time (40.6 vs 27.3 vs 29.4) over time. There was trend toward improved thrombolysis in cerebral infarction ≥ 2b recanalization rate (72.2% vs 77.8% vs 100%) over time. The introduction of a radial-specific catheter had a statistically significant positive impact on contrast use (133.8 vs 93 cc, P = .043), procedure time (54.2 vs 36.4 minutes, P = .003), fluoroscopy time (33.7 vs 19.8 minutes, P = .004), puncture-to-recanalization time (35.8 vs 25.1 minutes, P = .016), and thrombolysis in cerebral infarction ≥ 2b recanalization rate (71.4% vs 100%, P = .016). CONCLUSION: TRA is a safe and effective route of endovascular access for MT. Experience with this technique improves its efficacy and efficiency. The introduction of a TRA-specific catheter expands the armamentarium of the neurointerventionalist and may facilitate lesion access during MT procedures. Continued development of radial-specific devices may further improve MT outcomes.