Transradial access in acute ischemic stroke intervention.

Area of Science:

• Neuroendovascular interventions
• Vascular access techniques
• Stroke management

Background:

• Transfemoral access (TFA) is the standard for endovascular treatment of acute ischemic stroke (AIS).
• Complications or anatomical challenges with TFA can lead to delays in reperfusion therapy.
• Exploring alternative access routes is crucial for optimizing stroke treatment outcomes.

Purpose of the Study:

• To evaluate the feasibility and safety of transradial access (TRA) in patients undergoing interventional management for AIS.
• To assess the efficacy of TRA in achieving reperfusion in AIS cases.
• To compare outcomes when TRA is used as a primary strategy versus a bailout for TFA failure.

Main Methods:

• Retrospective review of AIS interventional databases from three tertiary academic centers.
• Identification and analysis of cases where TRA was utilized for endovascular stroke treatment.
• Data collection included patient demographics, stroke severity, access strategy, procedural details, and clinical outcomes.

Main Results:

• TRA was attempted in 15 (1.5%) of 1001 AIS patients, primarily due to TFA failure (12 cases) or as a primary strategy (3 cases).
• Successful clot engagement was achieved in 13 of 15 TRA attempts, with a mean time from radial puncture to reperfusion of 2.2 hours.
• Sixty percent of patients achieved Modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3 reperfusion via TRA, with no radial site complications reported.

Conclusions:

• Failure of transfemoral access in AIS endovascular treatment, though uncommon, results in significant reperfusion delays and poorer outcomes.
• Transradial access is a viable alternative for endovascular stroke treatment, particularly when TFA fails.
• Standardizing benchmarks for access site conversion can guide neurointerventionalists in managing complex AIS cases.