Abstract 444: Transradial versus transfemoral access for mechanical thrombectomy: A systematic review and meta‐analysis

IntroductionTransfemoral access (TFA) is a well‐established route for mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Besides routinely used in cardiology and other neuro‐interventional procedures, transradial access (TRA) is not commonly used for MT, owing to the necessity of larger guiding catheters and balloon guiding catheters. Less is known about the efficacy and security of this access site.MethodsPubMed, Embase and Cochrane database were searched for randomized controlled trials and non‐randomized studies that compared transradial versus transfemoral access for MT in patients with AIS and reported the outcomes of (1) significant access complications; (2) first pass effect; (3) puncture to reperfusion time; and (4) success recanalization final (mTICI 2b‐3). Heterogeneity was examined with I2 statistics. A random‐effects model was used for outcomes with high heterogeneity.ResultsWe included 1 randomized clinical trial and 11 non‐randomized studies with a total of 4445 patients, of whom 833 (18.7%) underwent direct TRA and 3612 (81.2%) received TFA. The proportion of patients with posterior circulation stroke was 57 (6.4%) TRA group and 112 (3.1%) in the TFA group. The incidence of significant access complications was significant lower on the TRA group (2.9%), as compared with the TFA group (7.1%) (OD 0.59; [0.38—0.91]; p=0.02; Figure 1A). First pass effect (OD 0.94; [0.72—1.23]; p=0.67) and puncture to reperfusion time (OD ‐1.66; [‐7.21—3.89]; p=0.56) was not significantly different between groups. Moreover, success recanalization was similar between both groups (OD 0.87; [0.61—1.23]; p=0.43; Figure 1B).ConclusionThese findings suggest that transradial access is safer and as effective as transfemoral access for mechanical thrombectomy and should be considered as an option for AIS due to LVO.