Barranco-Pons Roger, Caamaño Isabel Rodríguez, Guillen Anna Nuñez, Chirife Oscar Sabino, Quesada Helena, Cardona Pere
Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08017, Barcelona, Spain.
Service of Neurology, Hospital Universitari de Bellvitge, Fundació Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Neuroradiology. 2022 May;64(5):999-1009. doi: 10.1007/s00234-021-02850-4. Epub 2021 Nov 12.
To compare clinical outcomes and safety of transradial (TRA) versus transfemoral access (TFA) for endovascular mechanical thrombectomy in acute stroke patients.
Retrospective analysis of 832 consecutive patients with acute stroke undergoing interventional thrombectomy using TRA (n = 64) or TFA (n = 768).
Direct TFA failures occurred in 36 patients, 18 of which underwent crossover TFA to TRA, while direct TRA failures occurred in 2 patients having both crossovers to TFA. Successful catheterization was achieved in 96.8% (62/64) and 95.3% (732/768) of patients undergoing direct TRA and direct TFA, respectively, without significant differences. The median (IQR) catheterization time was 10 (8-16) min in the direct TRA group and 15 (10-20) in the direct TFA group (P < 0.001). This difference was also significant in the subgroup of anterior circulation strokes and in patients younger and older than 80 years of age. The majority of procedures yielded thrombolysis in cerebral infarction grade 2b/2c/3 revascularization in patients undergoing direct TRA (88.5%) and direct TFA (90.8%), without statistically significant differences. The median (IQR) puncture to recanalization time was 37 (24-58) min for the direct TRA group and 42 (28-70) min for the direct TFA group. Significant differences in access site complications, symptomatic ICH, and mRS score 0-2 at 90 days between both TRA and TFA accesses were not found.
TRA is not inferior to TFA in the probability of catheterization, times of catheterization and revascularization, and other clinical outcomes for mechanical thrombectomy in acute stroke.
比较急性卒中患者经桡动脉（TRA）与经股动脉入路（TFA）行血管内机械取栓术的临床疗效和安全性。
回顾性分析832例连续接受TRA（n = 64）或TFA（n = 768）介入取栓术的急性卒中患者。
36例患者直接TFA失败，其中18例改行TRA，2例直接TRA失败后改行TFA。直接TRA和直接TFA患者的成功置管率分别为96.8%（62/64）和95.3%（732/768），无显著差异。直接TRA组的中位（IQR）置管时间为10（8 - 16）分钟，直接TFA组为15（10 - 20）分钟（P < 0.001）。在前循环卒中亚组以及年龄小于和大于80岁的患者中，这种差异也很显著。大多数手术在直接TRA（88.5%）和直接TFA（90.8%）患者中实现了脑梗死溶栓2b/2c/3级再灌注，无统计学显著差异。直接TRA组的中位（IQR）穿刺至再通时间为37（24 - 58）分钟，直接TFA组为42（28 - 70）分钟。未发现TRA和TFA入路在穿刺部位并发症、症状性脑出血以及90天时mRS评分0 - 2方面存在显著差异。
在急性卒中机械取栓术的置管概率、置管和再灌注时间以及其他临床结局方面，TRA并不劣于TFA。
