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

In patients undergoing mechanical thrombectomy for acute ischemic stroke, a few studies have compared transradial access (TRA) to transfemoral access (TFA) with inconsistent results. We conducted this systematic review and meta-analysis to provide comprehensive evidence regarding the comparison of procedural and clinical outcomes of TRA versus TFA in patients with acute ischemic stroke undergoing mechanical thrombectomy.

We performed a comprehensive literature search of 4 electronic databases from inception until May 1, 2022. After title and full text screening, relevant data were extracted and then analyzed. For outcomes that constituted continuous data, the mean difference between the 2 groups and its SD were pooled. For outcomes that constituted dichotomous data, the frequency of events and the total number of patients in each group were pooled as odds ratio (OR) between the 2 groups.

Nine observational studies were included in this meta-analysis. The population of the studies was homogenous comprising a total of 2161 patients undergoing mechanical thrombectomy, including 446 patients via TRA and 1715 patients via TFA. There were no significant differences across the 2 groups in terms of successful recanalization (OR, 0.83 [95% CI, 0.55-1.25]; P=0.36), complete recanalization (OR 1.16 [95% CI, 0.50-2.68]; P=0.73), favorable functional outcomes (OR, 0.86 [95% CI, 0.53-1.41]; P=0.56), first-pass reperfusion (OR, 0.88 [95% CI, 0.64-1.19]; P=0.41), number of passes (mean difference, 0.12 [95% CI, -0.18 to 0.42]; P=0.43), access-to-reperfusion time (mean difference, -3.92 minutes [95% CI, -9.49 to 1.65]; P=0.17), or symptomatic intracranial hemorrhage (OR, 0.86 [95% CI, 0.47-1.57]; P=0.62). However, access site complications were significantly less frequent in the TRA group as compared with the TFA group (OR, 0.18 [95% CI, 0.06-0.51; P=0.001).

In patients undergoing mechanical thrombectomy for acute ischemic stroke, the collective evidence suggests that TRA seems to result in lower rates of access site complications than TFA without significant compromise in other clinical or procedural metrics. Randomized or prospective studies are warranted to confirm these results.