Evolution of Transradial Access for Mechanical Thrombectomy-A Single Center Experience.

Abstract

Transradial access (TRA) recently has gained popularity among neurointerventionalists. However, hesitation to its use for mechanical thrombectomy (MT) remains. To evaluate and describe the evolution of TRA for MT. We performed a retrospective analysis of patients undergoing TRA for MT. We performed a chronological ternary analysis to assess the impact of experience. We assessed the impact of a guide catheter designed specifically for TRA. We identified 53 patients who underwent TRA for MT. There was a statistically significant decrease in contrast use (148.9 vs 109.3 vs 115.2 cc), procedure time (62.4 vs 44.7 vs 41.3 minutes), fluoroscopy time (39.2 vs 44.7 vs 41.3 minutes), and puncture-to-recanalization time (40.6 vs 27.3 vs 29.4) over time. There was trend toward improved thrombolysis in cerebral infarction ≥ 2b recanalization rate (72.2% vs 77.8% vs 100%) over time. The introduction of a radial-specific catheter had a statistically significant positive impact on contrast use (133.8 vs 93 cc, P = .043), procedure time (54.2 vs 36.4 minutes, P = .003), fluoroscopy time (33.7 vs 19.8 minutes, P = .004), puncture-to-recanalization time (35.8 vs 25.1 minutes, P = .016), and thrombolysis in cerebral infarction ≥ 2b recanalization rate (71.4% vs 100%, P = .016). TRA is a safe and effective route of endovascular access for MT. Experience with this technique improves its efficacy and efficiency. The introduction of a TRA-specific catheter expands the armamentarium of the neurointerventionalist and may facilitate lesion access during MT procedures. Continued development of radial-specific devices may further improve MT outcomes.