Bram Richard, Nie James W, Theiss Peter, Marotta Dario, Hillman Maureen, Alaraj Ali, Atwal Gursant S
Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
Interv Neuroradiol. 2024 Nov 15:15910199241298725. doi: 10.1177/15910199241298725.
There has been debate in the literature regarding the adoption of a "radial-first" approach for mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Conflicting reports suggest that transradial access (TRA) may allow for shorter times to reperfusion while others conclude that long-term functional outcomes may favor transfemoral access (TFA). Here, we report a single-institution experience with the adoption of TRA as the primary route for acute stroke intervention.
We retrospectively reviewed a single-institution database of patients undergoing MT for AIS from March 2020 to April 2023. This time period was selected to capture the change in clinical practice at our institution from TFA to TRA. Primary and secondary outcomes included technical success, procedural complications, and long-term functional outcomes. Patients were stratified into two cohorts from initial access. Cohorts were compared utilizing inferential statistics.
A total of 192 consecutive cases were identified, with 80 in the TFA cohort and 112 in the TRA cohort. There was no difference in outcomes with respect to time from puncture to recanalization, rates of successful recanalization (TICI ≥ 2b), number of passes, rates of symptomatic intracranial hemorrhage (sICH), modified Rankin scale (mRS) at discharge and 90 days, and 90-day mortality ( ≥ 0.05, all). The TRA had a higher rate of access conversion ( < 0.001), while the TFA cohort had a higher rate of access site complications ( < 0.05).
关于在急性缺血性卒中（AIS）的机械取栓术（MT）中采用“桡动脉优先”方法，文献中一直存在争议。相互矛盾的报告表明，经桡动脉入路（TRA）可能使再灌注时间更短，而另一些研究则得出结论，长期功能结局可能更倾向于经股动脉入路（TFA）。在此，我们报告了一家机构采用TRA作为急性卒中干预主要途径的经验。
我们回顾性分析了2020年3月至2023年4月在本机构接受AIS的MT治疗的患者的单机构数据库。选择该时间段是为了记录我们机构从TFA到TRA的临床实践变化。主要和次要结局包括技术成功、手术并发症和长期功能结局。患者从初始入路被分为两个队列。利用推断性统计对队列进行比较。
共确定了192例连续病例，TFA队列80例，TRA队列112例。从穿刺到再通的时间、成功再通率（TICI≥2b）、通过次数、症状性颅内出血（sICH）发生率、出院时和90天时的改良Rankin量表（mRS）以及90天死亡率方面，两组结局无差异（均P≥0.05）。TRA的入路转换率更高（P<0.001），而TFA队列的入路部位并发症发生率更高（P<0.05）。
