Large-volume single-institution experience with transradial versus transfemoral mechanical thrombectomy in acute ischemic stroke: a retrospective cohort study.

Background: Transradial access (TRA) is increasingly common in cerebrovascular intervention, but its safety and efficacy in mechanical thrombectomy (MT) in acute ischemic stroke remain unclear.

Methods: We reviewed a prospectively maintained single-institution stroke database including consecutive cases between January 1, 2016 and December 31, 2023. Patients were categorized by initial access site, TRA or transfemoral access (TFA). Access site complications (ASCs) were tabulated and classified by Clavien-Dindo (CD) grade.

Results: 1121 patients were included (862 TFA, 259 TRA). TRA was associated with a mean 7.7 (95% CI 5.9 to 9.6) additional minutes from puncture-to-first-pass, and 7.7 (95% CI 4.8 to 10.6) additional minutes from puncture-to-recanalization. Among anterior circulation occlusions, TRA was associated with a 47% increase in the puncture-to-first-pass interval and a 27% increase in puncture-to-recanalization interval (P<0.001). Among posterior circulation occlusions, procedural times were not significantly different between TFA and TRA approaches. There were no significant differences in mean number of passes (1.7 vs 1.8, P=0.58), first pass successful recanalization rates (42.4% vs 45.6%, P=0.37), and post-procedural successful recanalization rates (67.2% vs 68.2%, P=0.76). Crossover rates were higher among the TRA group (5.8% vs 2.6%, P=0.01); ASCs and ASCs of CD grade >1 presented less frequently in the TRA group (12 (4.8%) vs 53 (6.1%), P=0.36; 4 (1.5%) vs 30 (3.5%), P=0.11, respectively), though both failed the predetermined threshold of statistical significance.

Conclusion: TRA MT was associated with similar posterior circulation but longer anterior circulation procedural times, overall similar rates of Thrombolysis In Cerebral Infarction (TICI) 2c/3 reperfusion, and similar neurologic outcomes when compared against TFA procedures.