Abstract WP147: The Effect Of Aortic Arch And Carotid Artery Anatomy Parameters On The Conversion From A Transradial Artery Approach To A Transfemoral Artery Approach For Mechanical Thrombectomy At A Comprehensive Stroke Center

Abstract

Introduction: Transradial approach (TRA) is emerging as an alternative to the traditional transfemoral approach (TFA) for mechanical thrombectomy (MT). We aim to identify various aortic arch and carotid artery anatomy parameters associated with a conversion from a TRA to a TFA for MT at a comprehensive stroke center (CSS). Methods: We performed a retrospective chart review of patients who underwent MT at a CSS from 1/2019 to 12/2021. We compared various aortic arch and carotid artery anatomy parameters between patients who had a successful MT via the TRA versus those who required a conversion from a TRA to a TFA for MT. A blinded board-certified neuroradiologist used the pre-MT CT Angiogram to document different aortic arch and carotid artery anatomy variables. A binary logistic regression analysis was performed, controlling for age, gender, presenting mean arterial pressure (MAP), presenting serum glucose, Hb A1C, LDL, left hemispheric location, and the location of occlusion [proximal (ICA or M1 segment of the middle cerebral artery) versus distal (M2 segment of the middle cerebral artery)]. Results: 68 patients met our inclusion criteria. The mean age was 66.08±15.09 years. 12 (17.65%) patients had to be converted from a TRA to a TFA for MT. In our cohort, the absence of a double subclavian-innominate curve (55.36% vs. 27.28%; OR, 12.5; 95 % CI, 1.76-88.52; P 0.011) and a higher diameter of the aortic arch at the apex (28.75±2.38mm vs.27.5±2.88mm; OR, 1.44; 95 % CI, 1.01-2.06; P 0.042) were significantly associated with a conversion from TRA to TFA. The other aortic arch and carotid artery anatomy parameters were not significantly associated with the conversion from a TRA to a TFA, as shown in the Table. Conclusion: Among aortic arch and carotid artery anatomy parameters, the absence of a double subclavian-innominate curve and a higher diameter of the aortic arch at the apex were significantly associated with a conversion from a TRA to a TFA for MT in our cohort.