Abstract Body (Do not enter title and authors here):
Background and Purpose
Transfemoral access (TFA) has been the standard for neuro-interventional procedures, but it carries risks such as pseudoaneurysm formation and arterial occlusion. Transradial access (TRA) is a newer alternative that may reduce these complications. This study aims to compare the clinical outcomes of TRA versus TFA in mechanical thrombectomy (MT) for acute ischemic stroke (AIS).
Methods
A systematic review and meta-analysis was conducted following PRISMA guidelines. Databases searched included PubMed/MEDLINE, Cochrane Library, and Google Scholar up to April 7, 2024. A random-effects model was used for analysis, and study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias (RoB 2) tool.
Results
The search identified 1389 records, and 13 studies (12 observational, 1 RCT) with 4803 patients (TRA: 855, TFA: 3948) were included. TRA showed no significant difference in successful recanalization (TICI 2b-3) compared to TFA [RR: 0.98; 95% CI: 0.94 – 1.03]. Complete recanalization (TICI 3) was also similar [RR: 1.08; 95% CI: 0.96 – 1.21]. Fluoroscopy time, reported by four studies, showed no significant difference [RR: -1.76; 95% CI: -7.54 – 4.02]. Hospital stay duration from three studies was comparable [MD: -0.52; 95% CI: -1.25 – 0.21]. The access-to-perfusion time reported by ten studies showed no significant difference [MD: -1.70; 95% CI: -8.11 – 4.72]. The mean number of passes from eight studies showed no significant difference [MD: 0.10; 95% CI: -0.06 – 0.27].
Procedural complications were lower in the TRA group but not statistically significant [6.09% vs. 8.77%, RR: 0.71; 95% CI: 0.46 – 1.09]. TRA had significantly fewer access site complications [RR: 0.23; 95% CI: 0.08 – 0.62]. Symptomatic intracranial hemorrhage from seven studies showed no significant difference [RR: 1.0; 95% CI: 0.72 – 1.38]. NIHSS score at discharge showed no significant difference [MD: 1.31; 95% CI: -2.14 – 4.76]. In-hospital mortality from two studies showed no significant difference [RR: 0.56; 95% CI: 0.26 – 1.20]. Ninety-day mortality from three studies showed no significant difference [RR: 1.15; 95% CI: 0.98 – 1.36].
Conclusion
TRA is as effective as TFA for MT in AIS and significantly reduces the risk of access site complications. Further large-scale RCTs are warranted to confirm these findings and refine the clinical guidelines for optimal access strategy in neuro-interventional procedures.