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Open Access

Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases

Timothy John Phillips, Matthew Thomas Crockett, Gregory D Selkirk, Ruchi Kabra, Albert Ho Yuen Chiu, Tejinder Singh, Constantine Phatouros, William McAuliffe
DOI: 10.1136/svn-2020-000624 Published 16 November 2020
Timothy John Phillips
1Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
2Neurological Intervention and Imaging Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Matthew Thomas Crockett
1Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
3Neurological Intervention and Imaging Service of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
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Gregory D Selkirk
1Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
3Neurological Intervention and Imaging Service of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
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Ruchi Kabra
1Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
2Neurological Intervention and Imaging Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Albert Ho Yuen Chiu
1Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
2Neurological Intervention and Imaging Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Tejinder Singh
1Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
2Neurological Intervention and Imaging Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Constantine Phatouros
1Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
3Neurological Intervention and Imaging Service of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
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William McAuliffe
1Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
3Neurological Intervention and Imaging Service of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
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Article Figures & Data

Tables

  • Table 1

    Patient, disease and treatment characteristics

    Categorical and dichotomous variablesWhole cohortFemoralRadialPearson χ2
    Pre-stroke independence (mRS 0–2)90.1% (338/375)88.2% (216/245)93.8% (122/130)OR 2.05 (0.91–4.62) p=0.079
    Operator three performing procedure35.2% (132/375)6.1% (15/245)90 .% (117/130)OR 138 (64–300) p=0.000
    Wake-up stroke/onset unknown31.5% (118/375)29.8% (73/245)34.6% (45/130)OR 1.25 (0.79–1.96) p=0.339
    Female50.7% (190/375)51.4% (126/245)49.2% (64/130)OR 0.92 (0.60–1.40) p=0.685
    Use of CTA95.7% (359/375)96.3% (236/245)94.6% (123/130)OR 0.67 (0.24–1.84) p=0.435
    Use of CTP65.6% (246/375)66.1% (162/245)64.6% (84/130)OR 0.94 (0.60–1.46) p=0.770
    Intracranial large vessel occlusion site
    Internal Carotid Artery24.3% (91/375)22.4% (55/245)27.7% (36/130)
    Middle Cerebral Artery M1 segment52 .% (195/375)51 .% (125/245)53.8% (70/130)
    Middle Cerebral Artery M2 segment23.5% (88/375)26.1% (64/245)18.5% (24/130)
    Aneterior Cerebral Artery0.3% (1/375)0.4% (1/245)0 .% (0/130)P=0.290 *Cochran–Mantel
    IV TPA prior to MT9.9% (37/375)11.8% (29/245)6.2% (8/130)OR 0.49 (0.22–1.10) p=0.079
    GA89.9% (337/375)91.4% (224/245)86.9% (113/130)OR 0.62 (0.32–1.23) p=0.169
    GA induction before arteriotomy35.9% (121/337)29.9% (67/224)47.8% (54/113)OR 2.14 (1.34–3.42) p=0.001
    Aspiration only (no stent-retriever)34.9% (131/375)31.4% (77/245)41.5% (54/130)OR 0.65 (0.42–1.00) p=0.051
    Carotid stenting16 .% (60/375)14.7% (36/245)18.5% (24/130)OR 1.31 (0.75–2.32) p=0.344
    Intracranial stenting5.6% (21/375)4.9% (12/245)6.9% (9/130)OR 1.44 (0.59–3.52) p=0.417
    Continuous variables—median (IQR)Whole cohortFemoralRadialMann-Whitney U test
    Age75 (64–84)76 (64–85)74 (62–83)P=0.375
    NIHSS14 (8.5–19)14 (8–19)15 (10–19)P=0.231
    RACE6 (3.5–8)6 (3–8)6 (5–8)P=0.140
    ASPECTS9 (8–10)9 (8–10)9 (8–10)P=0.053
    Onset/last known normal to ER presentation (mins)120 (65–401)110 (63.5–321)150 (65.5–602)P=0.103
    ER presentation to CT (min)17 (12–29)17 (12–27)18 (12–34)P=0.515
    CT to arteriotomy (min)59.5 (37–84)58.5 (35–85)60 (40–84)P=0.777
    Arteriotomy to reperfusion (min)29 (19–46.5)30 (20–40)25 (17–43)P=0.036
    CT to reperfusion (min)95.5 (70–126.5)96.5 (71–130)95 (68–123)P=0.456
    Days in MT hospital4 (2–8)4 (2–8)4 (2–7)P=0.888
    • ER, emergency room; GA, general anaesthesia; ICA, internal carotid artery; IV, intravenous; mRS, modified Rankin score; MT, mechanical thrombectomy.

  • Table 2

    Primary outcomes

    Primary outcomesWhole cohortFemoralRadialPearson χ2/Mann-Whitney U test
    mRS 0–2 at 90 days
    (in patients with prestroke mRS 0–2)
    61.3% (206/336)57.9% (124/214)67.2% (82/122)OR 1.49 (95% CI 0.93 to 2.37) p=0.092
    CT to reperfusion
    (median (IQR) min)
    95.5 (70–126.5)96.5 (71–130)95 (68–123)P=0.456
  • Table 3

    Secondary outcomes

    Categorical and dichotomous variablesWhole cohortFemoralRadialPearson χ2
    Arteriotomy cross-over2.7% (10/375)1.6% (4/245)4.6% (6/130)OR 2.92 (0.81–10.52) p=0.088
    First pass reperfusion54.7% (205/375)55.5% (136/245)53.1% (69/130)OR 0.91 (0.59–1.39) p=0.652
    Final angiographic result=eTICI 2B-394.4% (354/375)94.3% (231/245)94.6% (123/130)OR 1.06 (0.42–2.71) p=0.895
    sICH4 .% (15/375)4.9% (12/245)2.3% (3/130)OR 0.46 (0.13–1.66) p=0.223
    Access site complication requiring additional procedure4.3% (16/375)6.5% (16/245)0% (0/130)p=0.003
    mRS 0–2 at 90 days
    (in patients with pre-stroke mRS 0–2)
    61.3% (206/336)57.9% (124/214)67.2% (82/122)OR 1.49 (0.93–2.37) p=0.092
    Continuous variables - medians (IQR)Whole cohortFemoralRadialMann-Whitney U Test
    CT to arteriotomy59.5 (37–84)58.5 (35–85)60 (40–84)P=0.777
    Arteriotomy to reperfusion29 (19–46.5)30 (20–40)25 (17–43)P=0.036
    CT to reperfusion95.5 (70–126.5)96.5 (71–130)95 (68–123)P=0.456
    Days in MT hospital4 (2–8)4 (2–8)4 (2–7)P=0.888
    • mRS, modified Rankin score; MT, mechanical thrombectomy; sICH, symptomatic intracranial haemorrhage.

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Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases
Timothy John Phillips, Matthew Thomas Crockett, Gregory D Selkirk, Ruchi Kabra, Albert Ho Yuen Chiu, Tejinder Singh, Constantine Phatouros, William McAuliffe
Stroke and Vascular Neurology Nov 2020, svn-2020-000624; DOI: 10.1136/svn-2020-000624

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Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases
Timothy John Phillips, Matthew Thomas Crockett, Gregory D Selkirk, Ruchi Kabra, Albert Ho Yuen Chiu, Tejinder Singh, Constantine Phatouros, William McAuliffe
Stroke and Vascular Neurology Nov 2020, svn-2020-000624; DOI: 10.1136/svn-2020-000624
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Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases
Timothy John Phillips, Matthew Thomas Crockett, Gregory D Selkirk, Ruchi Kabra, Albert Ho Yuen Chiu, Tejinder Singh, Constantine Phatouros, William McAuliffe
Stroke and Vascular Neurology Nov 2020, svn-2020-000624; DOI: 10.1136/svn-2020-000624
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