Kobeissi Hassan, Ghozy Sherief, Liu Michael, Adusumilli Gautam, Bilgin Cem, Kadirvel Ramanathan, Kallmes David F, Brinjikji Waleed
Medicine, Central Michigan University College of Medicine, Mt. Pleasant, USA.
Neuroradiology, Mayo Clinic, Rochester, USA.
Cureus. 2022 Jul 5;14(7):e26589. doi: 10.7759/cureus.26589. eCollection 2022 Jul.
Mechanical thrombectomy for acute ischemic stroke (AIS) is traditionally performed via transfemoral access. While the majority of AISs are due to anterior circulation large vessel occlusions (AC-LVO), we performed a systematic review and meta-analysis to examine the feasibility of and outcomes following a transradial artery access for posterior circulation large vessel occlusion (PC-LVO) strokes. A systematic literature review of the English language literature was conducted using PubMed, MEDLINE, and Embase as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes of interest included 90-day modified Rankin scale (mRS) 0-2, puncture to recanalization time, and thrombolysis in cerebral infarction (TICI) scores 2b/3 and 3. We calculated pooled event rates and their corresponding 95% confidence intervals (CI) for all outcomes. We included seven studies with 68 patients in our analysis. All patients underwent mechanical thrombectomy via transradial artery access for AIS due to PC-LVO. The pooled meantime of puncture to recanalization was 29.19 (95% CI=24.05 to 35.42) minutes. Successful recanalization (TICI2b/3) was achieved in 98.69% (95% CI=93.50 to 100) of patients and complete recanalization (TICI 3) in 52.16% (95% CI=34.18 to 79.60) of the patients. Overall, 56.84% (95% CI=41.26 to 78.30) of patients achieved mRS 0-2. Transradial artery access for mechanical thrombectomy for PC-LVO stroke displays early promise and feasibility, particularly regarding very high rates of successful recanalization and low puncture to recanalization time.
急性缺血性卒中（AIS）的机械取栓术传统上是通过股动脉入路进行的。虽然大多数AIS是由前循环大血管闭塞（AC-LVO）引起的，但我们进行了一项系统评价和荟萃分析，以研究经桡动脉入路治疗后循环大血管闭塞（PC-LVO）性卒中的可行性和预后。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，使用PubMed、MEDLINE和Embase对英文文献进行了系统的文献综述。感兴趣的结局包括90天改良Rankin量表（mRS）评分为0-2、穿刺至再通时间以及脑梗死溶栓（TICI）评分2b/3和3。我们计算了所有结局的合并事件发生率及其相应的95%置信区间（CI）。我们的分析纳入了7项研究，共68例患者。所有患者均因PC-LVO通过经桡动脉入路接受了AIS的机械取栓术。穿刺至再通的合并平均时间为29.19分钟（95%CI=24.05至35.42）。98.69%（95%CI=93.50至100）的患者实现了成功再通（TICI2b/3），52.16%（95%CI=34.18至79.60）的患者实现了完全再通（TICI 3）。总体而言，56.84%（95%CI=41.26至78.30）的患者mRS评分为0-2。经桡动脉入路进行PC-LVO性卒中的机械取栓术显示出早期的前景和可行性，特别是在成功再通率非常高和穿刺至再通时间短方面。
