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Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases

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Stroke & Vascular Neurology 2021年第2期6卷 207-213页

作者： Timothy John Phillips matthew thomas crockett Gregory D Selkirk Ruchi Kabra Albert Ho Yuen Chiu Tejinder Singh Constantine Phatouros William McAuliffe Neurological Intervention and Imaging Service of Western Australia Sir Charles Gairdner HospitalPerthWestern AustraliaAustralia Neurological Intervention and Imaging Service of Western Australia Fiona Stanley HospitalPerthWestern AustraliaAustralia Neurological Intervention and Imaging Service of Western Australia Royal Perth HospitalPerthWestern AustraliaAustralia

Objective To compare transradial artery access(TRA)to the gold standard of transfemoral artery access(TFA)in mechanical thrombectomy(MT)for stroke caused by anterior circulation large vessel *** The clinical outcomes,procedural speed,angiographic efficacy and safety of both techniques were analysed in 375 consecutive cases over an 18-month period in a high volume statewide neurointerventional *** There was no significant difference in patient characteristics,stroke parameters,imaging techniques or intracranial *** median time elapsed between CT scanning and reperfusion was 96.5 min(IQR 68-123)in the TFA group and 95 min(IQR 68-123)in the TRA group(p=0.456).Of 336 patients who were independent at presentation 58%(124/214)of the TFA group and 67%(82/122)of the TRA group had a modified Rankin score of 0-2 at 90-day follow-up(p=0.093).Cross-over from radial to femoral was 4.6%(4/130)compared with 1.6%cross-over from femoral to radial(4/245),but did not meet the predetermined level of statistical significance(OR2.92,95% CI 0.81 to 10.52,p=0.088) and did not impact median procedural *** angiographic reperfusion,first pass reperfusion,embolisation to new territory and symptomatic intracranial haemorrhage were similar in both *** was a significant difference in major access site complications requiring an additional *** of the TRA cases had a major access site complication but 6.5%(16/245)of the TFA cases did(p=0.003).Conclusion This study suggests that using TRA for anterior circulation MT is fast,efficacious,safe and not inferior to the gold standard of TFA.

关键词： service radial cases

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