TY - JOUR
T1 - Comparison between transradial and transfemoral mechanical thrombectomy for ICA and M1 occlusions
T2 - insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)
AU - STAR Collaborators
AU - Silva, Michael A.
AU - Elawady, Sameh Samir
AU - Maier, Ilko
AU - Al Kasab, Sami
AU - Jabbour, Pascal
AU - Kim, Joon Tae
AU - Wolfe, Stacey Q.
AU - Rai, Ansaar
AU - Psychogios, Marios Nikos
AU - Samaniego, Edgar A.
AU - Goyal, Nitin
AU - Yoshimura, Shinichi
AU - Cuellar, Hugo
AU - Grossberg, Jonathan A.
AU - Alawieh, Ali
AU - Alaraj, Ali
AU - Ezzeldin, Mohamad
AU - Romano, Daniele G.
AU - Tanweer, Omar
AU - Mascitelli, Justin
AU - Fragata, Isabel
AU - Polifka, Adam J.
AU - Siddiqui, Fazeel M.
AU - Osbun, Joshua W.
AU - Crosa, Roberto Javier
AU - Matouk, Charles
AU - Levitt, Michael R.
AU - Brinjikji, Waleed
AU - Moss, Mark
AU - Dumont, Travis M.
AU - Williamson, Richard
AU - Navia, Pedro
AU - Kan, Peter
AU - De Leacy, Reade Andrew
AU - Chowdhry, Shakeel A.
AU - Spiotta, Alejandro M.
AU - Park, Min S.
AU - Starke, Robert M.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024
Y1 - 2024
N2 - Background: The role for the transradial approach for mechanical thrombectomy is controversial. We sought to compare transradial and transfemoral mechanical thrombectomy in a large multicenter database of acute ischemic stroke. Methods: The prospectively maintained Stroke Thrombectomy and Aneurysm Registry (STAR) was reviewed for patients who underwent mechanical thrombectomy for an internal carotid artery (ICA) or middle cerebral artery M1 occlusion. Multivariate regression analyses were performed to assess outcomes including reperfusion time, symptomatic intracerebral hemorrhage (ICH), distal embolization, and functional outcomes. Results: A total of 2258 cases, 1976 via the transfemoral approach and 282 via the transradial approach, were included. Radial access was associated with shorter reperfusion time (34.1 min vs 43.6 min, P=0.001) with similar rates of Thrombolysis in Cerebral Infarction (TICI) 2B or greater reperfusion (87.9% vs 88.1%, P=0.246). Patients treated via a transradial approach were more likely to achieve at least TICI 2C (59.6% vs 54.7%, P=0.001) and TICI 3 reperfusion (50.0% vs 46.2%, P=0.001), and had shorter lengths of stay (mean 9.2 days vs 10.2, P<0.001). Patients treated transradially had a lower rate of symptomatic ICH (8.0% vs 9.4%, P=0.047) but a higher rate of distal embolization (23.0% vs 7.1%, P<0.001). There were no significant differences in functional outcome at 90 days between the two groups. Conclusions: Radial and femoral thrombectomy resulted in similar clinical outcomes. In multivariate analysis, the radial approach had improved revascularization rates, fewer cases of symptomatic ICH, and faster reperfusion times, but higher rates of distal emboli. Further studies on the optimal approach are necessary based on patient and disease characteristics.
AB - Background: The role for the transradial approach for mechanical thrombectomy is controversial. We sought to compare transradial and transfemoral mechanical thrombectomy in a large multicenter database of acute ischemic stroke. Methods: The prospectively maintained Stroke Thrombectomy and Aneurysm Registry (STAR) was reviewed for patients who underwent mechanical thrombectomy for an internal carotid artery (ICA) or middle cerebral artery M1 occlusion. Multivariate regression analyses were performed to assess outcomes including reperfusion time, symptomatic intracerebral hemorrhage (ICH), distal embolization, and functional outcomes. Results: A total of 2258 cases, 1976 via the transfemoral approach and 282 via the transradial approach, were included. Radial access was associated with shorter reperfusion time (34.1 min vs 43.6 min, P=0.001) with similar rates of Thrombolysis in Cerebral Infarction (TICI) 2B or greater reperfusion (87.9% vs 88.1%, P=0.246). Patients treated via a transradial approach were more likely to achieve at least TICI 2C (59.6% vs 54.7%, P=0.001) and TICI 3 reperfusion (50.0% vs 46.2%, P=0.001), and had shorter lengths of stay (mean 9.2 days vs 10.2, P<0.001). Patients treated transradially had a lower rate of symptomatic ICH (8.0% vs 9.4%, P=0.047) but a higher rate of distal embolization (23.0% vs 7.1%, P<0.001). There were no significant differences in functional outcome at 90 days between the two groups. Conclusions: Radial and femoral thrombectomy resulted in similar clinical outcomes. In multivariate analysis, the radial approach had improved revascularization rates, fewer cases of symptomatic ICH, and faster reperfusion times, but higher rates of distal emboli. Further studies on the optimal approach are necessary based on patient and disease characteristics.
KW - Angiography
KW - Stroke
KW - Technique
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85186110971&partnerID=8YFLogxK
U2 - 10.1136/jnis-2023-021358
DO - 10.1136/jnis-2023-021358
M3 - Article
C2 - 38388480
AN - SCOPUS:85186110971
SN - 1759-8478
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
M1 - jnis-2023-021358
ER -