Abstract WP35: A Comparison of Transradial versus Transfemoral Access in Anterior Circulation Mechanical Thrombectomy

Abstract

Background: The transradial approach (TRA) to endovascular procedures decreases access site morbidity and mortality when compared to the traditional transfemoral technique (TFA). Despite its improved safety profile, there remains concerns that performing mechanical thrombectomy (MT) via TRA may lead to longer revascularization times and thus worse outcomes. However, TRA may confer an added benefit in mechanical thrombectomy (MT) where navigation of challenging aortic arch and carotid anatomy is often facilitated by a right radial artery trajectory. In this study, we compare technical and clinical outcomes in patients who underwent MT via TRA versus TFA. Methods: We performed a retrospective review of our institutional database to identify 51 patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion between February 2015 and February 2017. Patient characteristics, procedural techniques, and outcomes were recorded and TFA and TRA cohorts were compared. Results: Of the 51 patients, 35% of patients (n=18) underwent MT via TRA. There were no significant differences between the cohorts in patient characteristics, clot location, or aortic arch type and presence of ICA tortuosity. There were no significant differences in technical or clinical outcomes between the 2 cohorts, including rates of single-pass recanalization (54.6% vs. 55.6%, p=0.949) and average number of passes (1.9 vs. 1.7, p=0.453). Mean time from vascular access to reperfusion (61.9 vs. 61.1 mins, p=0.920), rates of successful revascularization (>= TICI2b; 87.9% vs. 88.9%, p=1.0) and functional outcomes (mRS >=2, 39.4% vs. 33.3%, p=0.669) were also similar between the TFA and TRA cohorts, respectively. Conclusions: Our results demonstrate equivalence in efficacy and efficiency between transradial and transfemoral access for MT in acute large vessel occlusion in the anterior circulation in patients with challenging vascular anatomy. Given the established advantage in access-site morbidity, our data suggests that the transradial approach may be superior to the transfemoral approach in well-selected patients undergoing MT.