Radial-sheath approach for large-bore mechanical thrombectomy using the Zebra laser-cut guide catheter: Initial...

BackgroundTransradial mechanical thrombectomy offers reduced complications compared to transfemoral approach but has been limited by the inability to safely deliver large-bore aspiration catheters through a radial sheath. The Food and Drug Administration (FDA)-cleared Zebra laser-cut catheter with 7F (0.087″ inner diameter; 0.096″ outer diameter) and 6F versions (0.074″ inner diameter; 0.083″ outer diameter) addresses this limitation.MethodsWe conducted a retrospective review of 26 patients undergoing transradial mechanical thrombectomy for acute ischemic stroke using the Zebra catheter through radial sheaths at two centers (January-August 2025). Primary outcomes included radial access success, recanalization (Thrombolysis in Cerebral Infarction [TICI] 2b-3), and access-site complications.ResultsMean age was 65.04 ± 12.82, mean National Institutes of Health Stroke Scale (NIHSS) was 20.88 ± 7.87. Radial access success rate was 96.2% (25/26). One conversion to femoral occurred due to catheter herniation at acute innominate-left common carotid angulation with aberrant right subclavian anatomy; the procedure was completed successfully via femoral route using the same system. Successful recanalization (TICI 2b-3) occurred in 88.5% (23/26) of patients. Zebra accommodated aspiration catheters ranging 0.055-0.071″ inner diameter and navigated complex anatomy including tortuous carotid origins with subclavian elevation up to 15 mm. No access-site complications occurred. Mean fluoroscopy time was 23.07 ± 18.24 min with 88.5% of procedures rated "easy" by the operator. Acute aortic branch angles represented the primary anatomical limitation, while distal tortuosity and moderate subclavian elevation were manageable.ConclusionZebra enabled transradial mechanical thrombectomy with high recanalization rates without access-site complications. Zebra succeeded across complex anatomy and demonstrated compatibility with various large bore suction catheters, allowing uniform utilization for thrombectomy in radial versus femoral access.