Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Can Transradial Mechanical Thrombectomy Be an Alternative in Case of Impossible Transfemoral Approach for Mechanical Thrombectomy? A Single Center's Experience

  • Cho, Hyun Wook (Department of Neurosurgery, Kangwon National University Hospital) ;
  • Jun, Hyo Sub (Department of Neurosurgery, Kangwon National University Hospital)
  • Received : 2020.08.19
  • Accepted : 2020.11.11
  • Published : 2021.01.01
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Abstract

Objective : Until recently, the transfemoral approach (TFA) was used as the primary method of arterial approach in acute ischemic stroke (AIS). However, TFA resulted in longer reperfusion times and worse outcomes in the mechanical thrombectomy (MT) of patients with complex aortic arches and significant carotid tortuosity. We found that the transradial approach (TRA) is a more favorable alternative approach for MT in such cases. Methods : We performed a retrospective review of our institutional database to identify 202 patients who underwent MT for AIS between February 2015 and December 2019. Patient characteristics, cause of TFA failure, procedure time, intra-procedural complications, and outcomes were recorded. Results : Eleven (5.4%) of 202 patients, who underwent MT for AIS, crossed over to TRA for recanalization, and eight (72%) of 11 achieved successful recanalization (≥modified Treatment in Cerebral Infarction 2b). The mean age (mean±standard deviation [median]) was 82.3±6.6 (76) years, and five of the 11 patients were male. The last seen normal to puncture time was 467.9±264.72 (264) minutes; baseline National Institutes of Health Stroke Scale score was 28.9±14.5 (16). Six (55%) of the 11 patients had right vertebrobasilar occlusions, and the remaining five (45%) had anterior circulation occlusive disease. The time from groin puncture to final recanalization time (overall procedural time) was 78.0±20.1 (62) minutes. The mean crossover time from TFA to TRA was 45.2±10.5 (41) minutes. The mean time from radial puncture to final recanalization was 33.8±10.5 (28) minutes. Distal thrombus migration events in previously unaffected territories occurred in 3/8 patients (37%). At 90 days, three patients (28%) had a favorable clinical outcome. Conclusion : Although rare, failure of TFA has been known to occur during MT for AIS. Our results demonstrate that TRA may be an alternative option for AIS intervention for select patients with subsequent timely revascularization. However, the incidence of distal thrombus migration was high, and the first puncture to reperfusion time was prolonged because of the time taken for the crossover to TRA after failure of TFA. This study provides some evidence that the TRA may be a viable alternative option to the TFA for MT of AIS.

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References

  1. Almallouhi E, Al Kasab S, Sattur MG, Lena J, Jabbour PM, Sweid A, et al. : Incorporation of transradial approach in neuroendovascular procedures: defining benchmarks for rates of complications and conversion to femoral access. J Neurointerv Surg 12 : 1122-1126, 2020 https://doi.org/10.1136/neurintsurg-2020-015893
  2. Beer-Furlan A, Joshi KC, Munich SA : Radial access for acute stroke thrombectomy. Endovascular Today 19 : 66-68, 2020
  3. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. : A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372 : 11-20, 2015 https://doi.org/10.1056/NEJMoa1411587
  4. Boulanger M, Lapergue B, Turjman F, Touze E, Anxionnat R, Bracard S, et al. : First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: systematic review and meta-analysis. Interv Neuroradiol 25 : 244-253, 2019 https://doi.org/10.1177/1591019918821074
  5. Chen SH, Snelling BM, Sur S, Shah SS, McCarthy DJ, Luther E, et al. : Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes. J Neurointerv Surg 11 : 874-878, 2019 https://doi.org/10.1136/neurintsurg-2018-014485
  6. Chueh JY, Kang DH, Kim BM, Gounis MJ : Role of balloon guide catheter in modern endovascular thrombectomy. J Korean Neurosurg Soc 63 : 14-25, 2020 https://doi.org/10.3340/jkns.2019.0114
  7. Crockett MT, Selkirk GD, Chiu AHY, Singh TP, McAuliffe W, Phillips TJ : First line transradial access for posterior circulation stroke intervention; initial 12-month experience at a high volume thrombectomy center. J Clin Neurosci 78 : 194-197, 2020 https://doi.org/10.1016/j.jocn.2020.04.069
  8. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. : Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387 : 1723-1731, 2016 https://doi.org/10.1016/S0140-6736(16)00163-X
  9. Haussen DC, Nogueira RG, DeSousa KG, Pafford RN, Janjua N, Ramdas KN, et al. : Transradial access in acute ischemic stroke intervention. J Neurointerv Surg 8 : 247-250, 2016 https://doi.org/10.1136/neurintsurg-2014-011519
  10. Hess CN, Peterson ED, Neely ML, Dai D, Hillegass WB, Krucoff MW, et al. : The learning curve for transradial percutaneous coronary intervention among operators in the United States: a study from the National Cardiovascular Data Registry. Circulation 129 : 2277-2286, 2014 https://doi.org/10.1161/CIRCULATIONAHA.113.006356
  11. Jo KW, Park SM, Kim SD, Kim SR, Baik MW, Kim YW : Is transradial cerebral angiography feasible and safe? A single center's experience. J Korean Neurosurg Soc 47 : 332-337, 2010 https://doi.org/10.3340/jkns.2010.47.5.332
  12. Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, et al. : Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 377 : 1409-1420, 2011 https://doi.org/10.1016/S0140-6736(11)60404-2
  13. Joshi KC, Beer-Furlan A, Crowley RW, Chen M, Munich SA : Transradial approach for neurointerventions: a systematic review of the literature. J Neurointerv Surg 12 : 886-892, 2020 https://doi.org/10.1136/neurintsurg-2019-015764
  14. Kidwell CS, Jahan R, Alger JR, Schaewe TJ, Guzy J, Starkman S, et al. : Design and rationale of the mechanical retrieval and recanalization of stroke clots using embolectomy (MR RESCUE) trial. Int J Stroke 9 : 110-116, 2014 https://doi.org/10.1111/j.1747-4949.2012.00894.x
  15. Kim SH, Choi JH, Kang MJ, Cha JK, Kim DH, Nah HW, et al. : Efficacy of combining proximal balloon guiding catheter and distal access catheter in thrombectomy with stent retriever for anterior circulation ischemic stroke. J Korean Neurosurg Soc 62 : 405-413, 2019 https://doi.org/10.3340/jkns.2019.0007
  16. Oselkin M, Satti SR, Sundararajan SH, Kung D, Hurst RW, Pukenas BA : Endovascular treatment for acute basilar thrombosis via a transradial approach: initial experience and future considerations. Interv Neuroradiol 24 : 64-69, 2018 https://doi.org/10.1177/1591019917733709
  17. Patel P, Haussen DC, Nogueira RG, Khandelwal P : The neuro radialist. Interv Cardiol Clin 9 : 75-86, 2020
  18. Rajah GB, Lieber B, Kappel AD, Luqman AW : Distal transradial access in the anatomical snuffbox for balloon guide-assisted stentriever mechanical thrombectomy: technical note and case report. Brain Circ 6 : 60-64, 2020 https://doi.org/10.4103/bc.bc_22_19
  19. Ribo M, Flores A, Rubiera M, Pagola J, Mendonca N, Rodriguez-Luna D, et al. : Difficult catheter access to the occluded vessel during endovascular treatment of acute ischemic stroke is associated with worse clinical outcome. J Neurointerv Surg 5 Suppl 1 : i70-i73, 2013 https://doi.org/10.1136/neurintsurg-2012-010438
  20. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. : Mechanical thrombectomy for acute ischemic stroke: final results of the multi MERCI trial. Stroke 39 : 1205-1212, 2008 https://doi.org/10.1161/strokeaha.107.497115
  21. Spiotta AM, Vargas J, Turner R, Chaudry MI, Battenhouse H, Turk AS : The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome. J Neurointerv Surg 6 : 511-516, 2014 https://doi.org/10.1136/neurintsurg-2013-010726