E-122 The feasibility and efficacy of trans-radial access for mechanical thrombectomy in ischemic stroke: a systematic review of the literature

Background/Purpose The use of the radial artery to access the cervical and cerebral arteries is gaining popularity in the neuro-interventional field. This trans-radial approach (TRA) avoids the tortuosity that could be encountered in the aortic arch thereby shortening procedural times. This could be relevant in stroke endovascular thrombectomy procedures where time is critical. Large randomized controlled trials of coronary interventions have demonstrated that a TRA is associated with better outcomes and fewer access site complications than trans-femoral access (TFA). We conducted a systematic review to assess the safety and potential advantages of TRA for mechanical thrombectomy in adults with ischemic stroke. Materials and methods We conducted a Medline search of the literature, including studies published in full in the English language with ≥5 adult patients with acute ischemic stroke reporting on the procedures, success, and complications of TRA (± TFA). Clinical and procedural variables were extracted and tabulated. Results Sixty-eight studied were screened and five met our inclusion criteria. All studies were retrospective and conducted in the United States of America. A total of 73 patients with acute ischemic stroke underwent mechanical thrombectomy (median age 79 years, median initial NIHSS 18). In two studies, TFA was initially attempted but failed. Only one study included a TFA comparison group (n=33 patients). Mean access to reperfusion time was 76.3±36.0 minutes (median 61.1, range 35.8–132 minutes) in TRA vs. 54.0±29.0 minutes (median 54.0, range 46-–62 minutes) in TFA. Successful reperfusion (Thrombolysis in Cerebra Infarction score [TICI] ≥2b) was reported in 89% of the patients. Failure to reach the target occlusion was reported in 9% of TRA cases. Conclusion TRA shows promising efficacy and efficiency for endovascular thrombectomy. Some of the available literature mostly reflects TRA use as a rescue access after failure to obtain TFA resulting in delaying reperfusion. Whether the routine use of TRA will result in comparable reperfusion rates to TFA and faster time to reperfusion is to be shown. Future studies on the TRA in stroke need to separately report the results of learning-phase cases and rescue TRA access. Disclosures A. Kuczynski: None. M. Goyal: None. M. Almekhlafi: None.