Transradial access valid for treatment of acute ischaemic stroke

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According to a recent retrospective review, the transradial approach to mechanical embolectomy is a valid approach for the endovascular treatment of acute ischaemic stroke.

Study authors Diogo Haussen et al say in the Journal of NeuroInterventional Surgery that, the transfemoral approach for the treatment of acute ischaemic stroke has been primarily used by neurointerventionalists due to the adequate size for large diameter catheterisation and relatively low puncture-related complications. But despite significant advances in hardware technology and procedural techniques, groin characteristics such as severe atherosclerotic disease in iliofemoral arteries and prominent groin fat deposits may lead to significant difficulties in safe and effective sheath placement. They therefore sought to demonstrate the validity and feasibility of the transradial approach as an alternative in the interventional management of acute ischaemic stroke.

The investigation was carried out via a retrospective review of the local institutional acute ischaemic stroke interventional databases of three tertiary academic centres (Grady Memorial Hospital/Emory University; Jackson Memorial Hospital/University of Miami; and Long Island College Hospital), from which the use of transradial access was identified.

The authors found that altogether, transradial access was attempted in 15 (1.5%) of 1,001 patients. They report that, “At Grady/Emory, transradial access was attempted in nine of 616 patients undergoing intra-arterial therapy for acute ischaemic stroke, allowing clot engagement in seven. At Jackson/University of Miami, transradial access was attempted in five of 110 patients undergoing intra-arterial therapy and was successful in four. Lastly, transradial access was attempted and was successful in one out of 275 patients undergoing intra-arterial treatment at Long Island College Hospital.”

Haussen et al further report that transradial access was effective in allowing clot engagement in 13 of the 15 patients. In the other two cases, one patient had a hypoplastic radial artery that precluded sheath advancement and one had chronic innominate artery occlusion that could not be crossed. No radial puncture site complications were noted. At 90 days, two patients had a good clinical outcome and seven had died.

In conclusion, they write, “The transradial approach to mechanical embolectomy is a valid approach for the endovascular treatment of acute ischaemic stroke. Failure of transfemoral access in the endovascular treatment of acute ischaemic stroke is uncommon but leads to unacceptable delays in reperfusion and poor outcomes. Standardisation of benchmarks for access switch could serve as a guide to neurointerventionalists.”