Tshibangu Mpuekela, Theiss Peter, Abou-Mrad Tatiana, McGuire Laura Stone, Madapoosi Adrusht, Alaraj Ali
Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA.
Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA.
Clin Neurol Neurosurg. 2025 Feb;249:108670. doi: 10.1016/j.clineuro.2024.108670. Epub 2024 Dec 4.
This study evaluates the feasibility, safety, and efficiency of using a balloon guide catheter (BGC) through transradial access (TRA) for mechanical thrombectomy (MT) in patients with anterior circulation strokes.
A retrospective case series of patients who underwent MT using BGC through TRA for acute ischemic stroke in the anterior circulation was conducted. Data collected included procedural times (from puncture to revascularization), technical success, complication rates, and clinical outcomes. Patients' baseline characteristics, stroke severity, and post-procedural outcomes were also analyzed.
Thirty patients were included, with a mean age of 64.4 ± 13.6 years. The median admission NIHSS score was 13, and 17 % received intravenous thrombolysis before thrombectomy. Right-sided occlusions were more frequent (57 %). TRA was successful in 27 patients (90 %), with 3 (10 %) requiring conversion to femoral access. The median puncture-to-revascularization time was 32 minutes, and first-pass revascularization was achieved in 40 % of cases. A favorable TICI 2b or higher was accomplished in 97 %, with no access site complications. Hemorrhagic conversion occurred in 20 %, including one symptomatic intracerebral hemorrhage (3 %). At discharge, 57 % of patients had favorable outcomes (mRS 0-2), and by 90 days, 54 % achieved functional independence, with a mortality rate of 3 %.
This case series highlights the feasibility of using BGC through TRA in MT for anterior circulation strokes, demonstrating promising safety and efficiency. Future multicenter studies with larger cohorts are necessary to compare clinical outcomes of TRA versus transfemoral access and guide standardized protocols for stroke interventions.
本研究评估经桡动脉入路（TRA）使用球囊导引导管（BGC）对前循环卒中患者进行机械取栓（MT）的可行性、安全性和有效性。
对经TRA使用BGC进行前循环急性缺血性卒中MT的患者进行回顾性病例系列研究。收集的数据包括手术时间（从穿刺到血管再通）、技术成功率、并发症发生率和临床结局。还分析了患者的基线特征、卒中严重程度和术后结局。
纳入30例患者，平均年龄64.4±13.6岁。入院时美国国立卫生研究院卒中量表（NIHSS）评分中位数为13分，17%的患者在取栓前接受了静脉溶栓治疗。右侧闭塞更为常见（57%）。27例患者TRA成功（90%），3例（10%）需要转为股动脉入路。穿刺到血管再通的中位时间为32分钟，40%的病例实现首次通过血管再通。97%的患者实现了良好的脑梗死溶栓分级（TICI）2b或更高，且无穿刺部位并发症。20%的患者发生出血性转化，包括1例有症状的脑出血（3%）。出院时，57%的患者预后良好（改良Rankin量表评分0 - 2分），到90天时，54%的患者实现功能独立，死亡率为3%。
本病例系列突出了经TRA使用BGC对前循环卒中进行MT的可行性，显示出良好的安全性和有效性。未来需要开展更大样本量的多中心研究，以比较TRA与股动脉入路的临床结局，并指导卒中干预的标准化方案。
