Feasibility, efficacy, and safety of sheathless transradial mechanical thrombectomy in acute ischemic stroke: A meta-analysis.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-08-28 DOI:10.1007/s00234-025-03747-2

Ocílio Ribeiro Golçalves, Victor Arthur Ohannesian, Mariana Letícia de Bastos Maximiano, Henrique Maia, Marina Vilardo, Luis Fravio Fabrini Paleare, Christian Ken Fukunaga, João Victor Araujo de Oliveira, Társis Vinícius Cronemberger, Márcio Yuri Ferreira, Kelson James Almeida, João Paulo Mota Telles

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引用次数: 0

Abstract

Introduction: Mechanical thrombectomy (MT) is the standard of care for large vessel occlusions (LVO) in acute ischemic stroke (AIS), traditionally performed using transfemoral access (TFA). However, the sheathless transradial approach (sTRA) has emerged as a viable alternative, particularly for patients with complex vascular anatomies.

Objectives: This systematic review and meta-analysis aim to evaluate the feasibility, efficacy, and safety of sTRA in MT for AIS.

Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines, including observational studies that reported on MT using sTRA. Primary outcomes included the proportion of successful reperfusion (modified Treatment in Cerebral Infarction [mTICI] grade 2b-3), crossover rates from radial to femoral access, and symptomatic intracerebral hemorrhage (sICH). Secondary outcomes assessed were minor access site-related complications.

Results: A total of four studies were included, comprising 138 patients who underwent MT with sTRA. The pooled analysis revealed a high rate of successful reperfusion (97%; 95% CI: 95-100%), with a low crossover rate to TFA (3%; 95% CI: 0-7%). The incidence of sICH was low, at 4% (95% CI: 0-8%), and minor access site-related complications occurred in 5% of patients (95% CI: 2-9%).

Conclusion: This meta-analysis demonstrates that sTRA is a feasible and effective approach for MT in AIS, with a favorable safety profile. The technique offers high recanalization rates, low complication rates, and minimal need for crossover to TFA. Future randomized controlled trials comparing MT with sTRA and TFA are needed to confirm these results and refine patient selection criteria for this approach. Despite encouraging results, the small number of included studies and their observational design limit the generalizability of the findings. Therefore, further comparative and randomized trials are needed to validate these outcomes.

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急性缺血性卒中无鞘经桡动脉机械取栓术的可行性、有效性和安全性：一项荟萃分析。

导读：机械取栓（MT）是急性缺血性卒中（AIS）大血管闭塞（LVO）的标准治疗方法，传统上采用经股通道（TFA）。然而，无鞘经桡骨入路（sTRA）已成为一种可行的选择，特别是对于血管解剖结构复杂的患者。目的：本系统综述和荟萃分析旨在评估sTRA在治疗AIS的MT中的可行性、有效性和安全性。方法：我们根据PRISMA指南进行了系统回顾和荟萃分析，包括使用sTRA进行MT的观察性研究。主要结局包括再灌注成功的比例（改良治疗脑梗死[mTICI]分级2b-3），从桡骨到股骨通路的交叉率，以及症状性脑出血（siich）。次要结果评估为轻微的通路相关并发症。结果：共纳入4项研究，其中138例患者接受了sTRA的MT。合并分析显示再灌注成功率高（97%;95% CI: 95-100%），与TFA交叉率低（3%;95% CI: 0-7%）。siich的发生率很低，为4% (95% CI: 0-8%)， 5%的患者发生轻微的通路相关并发症（95% CI: 2-9%）。结论：本荟萃分析表明sTRA是一种可行且有效的治疗AIS MT的方法，具有良好的安全性。该技术的再通率高，并发症发生率低，并且很少需要交叉到TFA。未来需要将MT与sTRA和TFA进行比较的随机对照试验来证实这些结果，并完善该方法的患者选择标准。尽管结果令人鼓舞，但纳入的研究数量少及其观察设计限制了研究结果的普遍性。因此，需要进一步的比较和随机试验来验证这些结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.