• Joshua Feler, Matthew J Hagan, Elias Shaaya, Matthew Anderson, Jonathan Poggi, Carlin Chuck, Ankush Bajaj, Krisztina Moldovan, Ryan A McTaggart, Richard A Haas, Mahesh V Jayaraman, and Radmehr Torabi.
• Warren Alpert Medical School of Brown University, Providence, Providence, Rhode Island, USA; Department of Interventional Radiology and Neurosurgery, Rhode Island Hospital, Brown University, Providence, Providence, Rhode Island, USA.
• World Neurosurg. 2022 Sep 1; 165: e235e241e235-e241.

BackgroundTransradial access has been described for mechanical thrombectomy in acute stroke, and proximal balloon occlusion has been shown to improve recanalization and outcomes. However, sheathed access requires a larger total catheter diameter at the access site. We aimed to characterize the safety of sheathless transradial balloon guide catheter use in acute stroke intervention.MethodsConsecutive patients who underwent sheathless right-sided transradial access for thrombectomy with a balloon guide catheter were identified in a prospectively collected dataset from 2019 to 2021. Demographics, procedure details, and short-term outcomes were collected and reported with descriptive statistics.ResultsA total of 48 patients (20 women) with a mean age of 72.3 years were identified. Of patients, 56.3% had occlusions in the left-sided circulation; 35 (72.9%) had M1 occlusions, 7 (14.6%) had M2 occlusions, and 6 (12.5%) had internal carotid artery occlusions. Tissue plasminogen activator was administered to 16 (33.3%) patients. Five (10.4%) patients underwent intraprocedural carotid stenting. The cohort had successful reperfusion after a median of 1 (interquartile range: 1, 2) pass. Median time from access to recanalization was 31 (interquartile range: 25, 53) minutes. A postprocedural Thrombolysis In Cerebral Infarction score of ≥2b was achieved in 46 (95.8%) patients. Five patients had wrist access site hematomas. All hematomas resolved with warm compresses, and no further intervention was required.ConclusionsSheathless radial access using a balloon guide catheter may be safely performed for acute ischemic stroke with excellent radiographic outcomes. Further investigation is warranted to evaluate the comparative effectiveness of sheathless compared with sheathed transradial balloon guide access.Copyright © 2022. Published by Elsevier Inc.

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