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Distal Transradial Approach in Mechanical Thrombectomy: Technical Note.

Shunsuke Tanoue1, Kenichiro Ono1, Toru Yoshiura1

  • 1Department of Neurosurgery, Mishuku Hospital, Tokyo, Japan.

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|July 28, 2023
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Summary

Mechanical thrombectomy using the distal transradial approach (dTRA) is a viable option for treating acute ischemic stroke. This minimally invasive technique facilitated successful recanalization and rapid symptom improvement in a challenging patient case.

Keywords:
anterior circulationmechanical thrombectomymiddle cerebral arteryradial arterysnuff box

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Area of Science:

  • Neurology
  • Interventional Radiology
  • Vascular Surgery

Background:

  • Mechanical thrombectomy (MT) is a crucial treatment for acute ischemic stroke.
  • Vascular access for MT can be challenging in patients with complex aortic arch anatomy or comorbidities.
  • The distal transradial approach (dTRA) offers a less invasive alternative for vascular access.

Purpose of the Study:

  • To report a case of successful mechanical thrombectomy (MT) utilizing the distal transradial approach (dTRA).
  • To highlight technical considerations and potential benefits of dTRA in complex neurovascular interventions.

Main Methods:

  • A case presentation of an 89-year-old female with right middle cerebral artery (MCA) occlusion.
  • 3D-CTA confirmed MCA occlusion, and patient factors necessitated a challenging vascular access strategy.
  • dTRA was selected due to safety, accessibility, and reduced postoperative restrictions.

Main Results:

  • Successful first-pass recanalization of the MCA occlusion was achieved using an aspiration catheter and stent retriever.
  • The patient experienced rapid neurological symptom improvement.
  • Discharge with a modified Rankin Scale score of 1 indicated a favorable outcome.

Conclusions:

  • The distal transradial approach (dTRA) is a feasible and effective option for mechanical thrombectomy (MT) in select patients.
  • dTRA may offer advantages in cases with challenging vascular anatomy or when minimizing patient discomfort and immobility is desired.