Transradial versus transfemoral access in acute ischemic stroke thrombectomy: a meta-analysis

Transfemoral access (TFA) is the standard route for mechanical thrombectomy (MT) in acute ischemic stroke (AIS), while transradial access (TRA) is an emerging alternative with potential safety advantages. Comparative evidence on efficacy, safety, and access performance remains limited.

To compare TRA and TFA for MT in AIS through an updated systematic review and meta-analysis.

We searched PubMed, Ovid, Springer, and Cochrane (until May 2026) for randomized or observational studies directly comparing TRA and TFA in AIS MT. Outcomes assessed were access-site complications, access failure, key efficacy measures, functional outcomes, mortality, and recovery time.

Sixteen studies (1 RCT, 15 retrospective; 6307 patients: 1,288 TRA, 5,019 TFA) were included. Successful recanalization rates were similar (88.1% vs 87.7, P=0.79), as were complete recanalization, modified first-pass reperfusion, number of passes, and recanalization time. Access-site complications were fewer with TRA (3.4% vs 7.5%, P<0.0001), but access failure was more common (6.99% vs 2.18%, OR: 2.84, P<0.0001). Probability of a complication at the first access site was lower for TRA (3.9% vs 7.6%). Mortality (26.6% vs 27.8%, P=0.55) and functional independence (modified Rankin Scale (mRS) score 0-2: 37.4% vs 38.8%, P=0.47) did not differ.

TRA and TFA yield comparable recanalization and functional outcomes in AIS MT. TRA reduces access-site complications but has higher access failure, with overall lower initial access-site complication risk. Prospective, standardized comparisons across anatomical subgroups are warranted.