Transradial Versus Transfemoral Access for Mechanical Thrombectomy: A Systematic Review and Meta-Analysis

Area of Science:

• Interventional Neurology
• Vascular Neurology
• Medical Device Technology

Background:

• Mechanical thrombectomy is a key treatment for acute ischemic stroke.
• Transradial access (TRA) and transfemoral access (TFA) are common vascular access methods.
• Previous studies comparing TRA and TFA for stroke thrombectomy have yielded inconsistent results.

Purpose of the Study:

• To conduct a systematic review and meta-analysis comparing procedural and clinical outcomes of TRA versus TFA.
• To provide comprehensive evidence on the safety and efficacy of different vascular access methods in stroke thrombectomy.

Main Methods:

• A comprehensive literature search was conducted across 4 electronic databases up to May 1, 2022.
• Nine observational studies comprising 2161 patients (446 TRA, 1715 TFA) were included.
• Data on procedural metrics and clinical outcomes were extracted and analyzed using appropriate statistical methods for continuous and dichotomous data.

Main Results:

• No significant differences were observed between TRA and TFA in successful recanalization, complete recanalization, favorable functional outcomes, first-pass reperfusion, number of passes, or access-to-reperfusion time.
• Symptomatic intracranial hemorrhage rates were also similar between the two groups.
• Access site complications were significantly less frequent in the TRA group compared to the TFA group (OR, 0.18 [95% CI, 0.06-0.51]; P=0.001).

Conclusions:

• Transradial access (TRA) appears to be associated with lower rates of access site complications compared to transfemoral access (TFA) in patients undergoing mechanical thrombectomy for acute ischemic stroke.
• These benefits were achieved without compromising key procedural or clinical outcomes.
• Further randomized or prospective studies are recommended to validate these findings.