Abstract Body: Title: Efficacy and Safety of Transcarotid Approach for Mechanical Thrombectomy in Acute Ischemic Stroke: A Multicenter Study with Systematic Review and Meta-Analysis

Background:
Anatomical or technical challenges in certain patients during mechanical thrombectomy (MT) can render recanalization through distal access sites impossible. The transcarotid approach is a valuable rescue technique. Despite its potential, this approach is infrequently employed in clinical practice due to concerns about serious complications or operator unfamiliarity. As a result, the safety and efficacy of the transcarotid approach in MT remain insufficiently characterized.

Methods:
We conducted a multicenter two-arm case series comparing cases of acute ischemic stroke (AIS) with large vessel occlusion (LVO) that were managed with MT via the transcarotid approach to medical management alone after failed MT. We included our results in a systematic review and single-arm meta-analysis of the literature investigating the transcarotid approach for MT by pooling our cases with data from existing literature. The pooled data were reported as proportions or means with 95% confidence intervals (CI). Subsequently, we performed logistic and linear regressions using individual patient data from all studies to identify predictors of outcomes such as mortality and complications.

Results:
Nine studies were included in this systematic review and meta-analysis. MT with the transcarotid approach had a 31% complication rate (95% CI 0.23; 0.40), 37% mortality rate at 90 days (95% CI 0.27; 0.49), and 86% reperfusion rate (95% CI 0.79; 0.91). 38% of cases had mRS 0-3 at 90 days (95% CI 0.23; 0.56). Factors predicting complications were tPA use (OR 3.35, 95% CI 1.37; 8.24). Factors predicting mortality at 90 days were higher age (OR 1.04, 95% CI 1.01; 1.09), higher NIHSS at presentation (OR 1.10, 95% CI 1.01; 1.19) lower ASPECTS score (OR 0.70, 95% CI 0.47; 0.98), and higher mRS at discharge (OR 28, 95% CI 3.72; 211.3). Recanalization was associated with lower odds of mortality at 90 days (OR 0.30, 95% CI 0.08; 0.95).

Conclusion:
MT using the transcarotid approach is an effective rescue strategy for recanalization in the setting of failed femoral and radial access, with promising complication and mortality rates and excellent reperfusion rate. The proportion of transcarotid cases achieving mRS 0-3 at 90 days is comparable to the outcomes reported for traditional femoral access.