Transradial Versus Transfemoral Approach for Endovascular Thrombectomy of Left Anterior Circulation Stroke With Bovine Arch

HomeStroke: Vascular and Interventional NeurologyVol. 2, No. 4Transradial Versus Transfemoral Approach for Endovascular Thrombectomy of Left Anterior Circulation Stroke With Bovine Arch Open AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toOpen AccessEditorialPDF/EPUBTransradial Ching‐Jen Chen, Isaac Josh Abecassis Dale Ding ChenChing‐Jen Chen , Department Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, Search more papers by this author AbecassisIsaac Louisville, KY, DingDale *Correspondence to: Ding, MD, Louisville School Medicine, 220 Abraham Flexner Way, 15th Floor, KY 40202. E‐mail: E-mail Address: [email protected] https://orcid.org/0000-0002-2627-446X Originally published6 Jul 2022https://doi.org/10.1161/SVIN.122.000374Stroke: Neurology. 2022;2:e000374Adoption a “radial‐first” approach has become increasingly popular among contemporary neurointerventionalists. Congruent with interventional cardiology experiences, the transradial (TRA) in neuroendovascular procedures demonstrated improved safety profile compared traditional transfemoral (TFA).1, 3, 4 Such comparisons are particularly important endovascular management acute ischemic stroke, as these patients often taking antiplatelet or anticoagulant medications, many also receiving intravenous thrombolysis. In addition commonly metrics, catheter navigation time occlusion site is equally, if not more, important. Catheter times degree difficulty contingent on aortic arch carotid artery anatomy well choice (ie, TRA versus TFA).5, 6 Although studies comparing TFA stroke thrombectomies have reported comparable procedural clinical outcomes, included patient cohorts heterogeneous anatomy.4, 6, 7, 8, 9 been proposed favorable rapid intracranial access type II III bovine common origin innominate left arteries).6The study Maud et al10 highlights advantage over thrombectomy anterior circulation large‐vessel occlusion. This single‐center, retrospective comprised such 26 cases, evenly split between those who underwent (n=13 each). When TFA, authors shorter puncture microcatheter placement at clot interface (17.0±5.8 35.4±20.5 minutes; P=0.0001), recanalization (34.0±15.6 58.1±34.6 P=0.01), total fluoroscopy (13.8±9.4 29.5±18.0 P=0.03) TRA. addition, 2 required conversion other factors mentioned study, radial loop tortuosity subclavian arteries, affect ease TRA, configuration certainly provides easier selection without needing form Simmons catheter.5 A combination further underscores catheterizing maintaining stable construct internal whereas tends result herniation guide guiding sheath into ascending aorta.The found higher rate successful (Thrombolysis Cerebral Infarction ≥2b; 69.2% 53.8%; P=0.43), excellent outcome 3 months (modified Rankin Scale score 0–1; 38.5% 7.7%; P=0.06), lower symptomatic intracerebral hemorrhage (0% 15.4%). However, results should be interpreted caution, baseline characteristics were different. Specifically, cohort had National Institutes Health presentation (15.4±5.8 11.8±5.3), longer known normal hospital arrival (381.9±448.6 236.5 275.8 minutes), proportion premorbid functional independence (53.8% 84.6%). The tandem occlusions (23% 7.7%), which may increased case complexity duration. These between‐group differences likely contributed poorer outcomes cohort.Achieving shortest possible remains goal management. it unclear from whether 24 minutes gained using because dissimilar cohorts. It faster revascularization achieved was imprecision small sample size complexity. larger that balances could demonstrate particular subgroup, scales (eg, modified Scale) resolution sensitivity detect potential improvements correlate magnitude improvement. Finally, appear comfortable but their saved generalizable centers neurointerventionalists less experience. Albeit, pathology removes one time‐ experience‐limiting steps select artery.Given considerable variability vascular encountered during thrombectomy, challenging compartmentalize each variant approach. revascularize through optimism can hampered tortuosity. Therefore, interventions, assessed case‐by‐case basis based preprocedural noninvasive angiography practitioner's experience comfort level TFA.Sources FundingNone.DisclosureNone.AcknowledgmentsNone.Footnotes*Correspondence [email protected] an editorial response SVIN/2021/000243R1.The opinions expressed article necessarily editors, American Heart Association, Society Neurology.References1 Roule V, Lemaitre A, Sabatier R, Lognoné T, Dahdouh Z, Berger L, Milliez P, Grollier G, Montalescot Beygui F. Transradial percutaneous coronary intervention cardiogenic shock: radial‐first centre meta‐analysis published studies. Cardiovasc Dis. 2015; 108:563–575.CrossrefGoogle Scholar2 Brener MI, Bush Miller JM, Hasan RK. Influence femoral outcomes: systematic review meta‐analysis. Interv. 2017; 90:1093–1104.CrossrefGoogle Scholar3 Almallouhi E, Al Kasab S, Sattur MG, Lena J, Jabbour PM, Sweid Chalouhi N, Gooch MR, Starke RM, Peterson EC, al. Incorporation procedures: defining benchmarks rates complications access. J Neurointerv Surg. 2020; 12:1122–1126.CrossrefGoogle Scholar4 Khanna O, Velagapudi Das Mouchtouris Saiegh F, Avery MB, Schmidt RF, Sajja K, comparison interventions. Neurosurg. 2020:1–6. https://doi.org/10.3171/2020.7.JNS201174Google Scholar5 Khan NR, Dornbos Iii D, Nguyen Goyal Torabi Hoit Elijovich Inoa‐Acosta Morris Predicting trans‐radial cerebral angiography. 2021; 13:552–558.CrossrefGoogle Scholar6 SH, Snelling BM, Sur Shah SS, McCarthy DJ, Luther Yavagal DR, RM. mechanical thrombectomy: technical outcomes. 2019; 11:874–878.Google Scholar7 Munich SA, Vakharia McPheeters MJ, Waqas M, Tso MK, Levy EI, Snyder KV, Siddiqui AH, Davies JM. Transition thrombectomy‐lessons learned single‐center series. Oper Neurosurg (Hagerstown). 19:701–707.CrossrefGoogle Scholar8 Phillips TJ, Crockett MT, Selkirk GD, Kabra Chiu AHY, Singh Phatouros C, McAuliffe W. analysis 375 consecutive cases. Vasc Neurol. 6:207–213.CrossrefGoogle Scholar9 Neumaier Zhang JF, Dossani RH, Cappuzzo Van Coevering RJ, Rai HH, Monteiro Sonig Radial first first: series intervention. 13:687–692.CrossrefGoogle Scholar10 Moreno Sheriff Chaudry MRA, Gupta Khatri Rodriguez G. arch. Interv 2022; 1.Google Scholar eLetters(0)eLetters relate recently journal forum providing unpublished data. Comments reviewed appropriate use tone language. peer-reviewed. Acceptable comments posted website only. issue indexed PubMed. no than 500 words will only online. References limited 10. Authors cited comment invited reply, appropriate.Comments feedback AHA/ASA Scientific Statements Guidelines directed Manuscript Oversight Committee via its Correspondence page.Sign Submit Response Article Previous Back top Next FiguresReferencesRelatedDetails July 2022Vol Issue InformationMetrics © 2022 Authors. Published behalf Inc., Neurology Wiley Periodicals LLC.This open under terms Creative Commons Attribution‐NonCommercial License, permits use, distribution reproduction any medium, provided original work properly used commercial purposes.https://doi.org/10.1161/SVIN.122.000374 receivedFebruary 24, 2022Manuscript acceptedMarch 1, 2022Originally publishedJuly KeywordsEditorialsendovascular proceduresradial accessstrokethrombectomybovine archtransradialPDF download