Breaking barriers in stroke care: the role of peripheral interventional radiologists in mechanical thrombectomy

To report the results of a Peripheral Interventional Radiology Unit in the endovascular treatment of acute ischemic stroke (AIS) and describe the training model previously adopted.

A retrospective analysis was conducted on all endovascular thrombectomy (EVT) procedures performed by the interventional radiology unit of a single center, after a dedicated training, between June 2022 and June 2024. Inclusion criteria included AIS patients treated with EVT for anterior circulation LVO with available pre- and post-procedural imaging. Good clinical outcomes (three-month modified Rankin Scale (mRS) 0-2) and successful revascularization (a TIMI score of ≥ 2b) were assessed. Procedural metrics, clinical outcomes, and complication rates were assessed.

Among 148 thrombectomy procedures, 112 patients met inclusion criteria (mean age 72.8 years; 50% male). Successful recanalization (mTICI 2b-3) was achieved in 89% of cases. The median time from symptom onset to groin puncture was 170 min (IQR 70-280), with a median groin-to-recanalization time of 30 min [IQR 20-45]. Systemic thrombolysis was administered to 59% of patients. Functional independence (mRS ≤ 2) at three months was achieved in 58% of patients. The average NIHSS baseline was 15.3 and at discharge was 7. The three-month mortality rate was 15%. Intracranial hemorrhage after reperfusion therapy was 4.9%. Three patients had major intraprocedural complication.

Peripheral IRs with vascular expertise can be effectively trained to perform EVT, achieving comparable outcomes to neurointerventional dedicated radiologist. The integration of trained IRs into stroke workflows reduced treatment delays and expanded EVT access.