Initial experience of utilizing a lower-profile transradial approach for mechanical thrombectomy: Comparable efficacy to larger-bore transfemoral approaches

Abstract

Background

While transfemoral access is commonly used for mechanical thrombectomy (MT) due to large-bore catheters providing greater aspiration forces, some centers employ transradial access (TRA) in select cases with favorable anatomy. We report our institutional experience to evaluate the efficacy of using TRA as the default approach for large-vessel occlusion (LVO) with a streamlined, lower-profile system.

Methods

A retrospective review was conducted on 23 consecutive thrombectomies performed via TRA, regardless of patient anatomy or LVO location. Demographic and procedural variables were collected.

Results

Among the 23 patients (median age 72 years; 52% female; 57% white), occlusions were primarily in the M1 territory (44%) and carotid terminus artery (13%). The average time to first pass was 10 ± 7.7 min, and time to recanalization (thrombolysis in cerebral infarction [TICI] ≥2b) was 16 ± 12.5 min. Intracranial atherosclerosis requiring stenting or balloon angioplasty occurred in 20% of cases. For these patients, mean recanalization time was 17 ± 13.6 min; for those requiring thrombectomy alone, it was 8.8 ± 5.1 min, all achieving TICI ≥2b in a single pass. Final TICI scores were 3 in 73% of cases, 2c in 23%, and 2b in 4%.

Conclusion

A streamlined, lower-profile TRA system can effectively serve as an upfront modality for MT and appears to perform comparably to larger-bore, transfemoral alternatives. This technique offers the benefits of TRA without compromising efficacy.