• World Neurosurg · Nov 2023

    Crossover from Femoral to Radial Access during Mechanical Thrombectomy of Large Vessel Occlusion Stroke.

    • Yimin Chen, Anurag Sahoo, Xiaodong Cai, Mohammad Mofatteh, Asim Z Mian, Hao Lin, Shuiquan Yang, Thanh N Nguyen, and Mohamad Abdalkader.
    • Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, China; Neuro International Collaboration, Foshan, China.
    • World Neurosurg. 2023 Nov 1; 179: e281e287e281-e287.

    BackgroundChallenging arterial anatomy may prevent timely endovascular treatment (EVT) of acute ischemic stroke (AIS) through a transfemoral approach prompting the use of alternative access routes. We determined the crossover rate from femoral to radial access during EVT of AIS due to large vessel occlusion and identified its radiological predictors and clinical outcomes.Materials And MethodsRetrospective review of all AIS patients who underwent EVT at a single institution from January 2016 to March 2021 was performed. A primary and a secondary radial group depending on whether the radial approach was used primarily or secondary to failure of transfemoral approach were compared.ResultsA total of 358 consecutive AIS patients with large vessel occlusion underwent EVT. Radial approach was used primarily in 6 patients (primary radial [PR]) and secondarily in 16 patients (secondary radial [SR]). The rate of femoral to radial crossover was 4.7%. Type III arch and bovine arch configurations were the most common characteristic in the crossover group. Radial access was successful to secure intracranial access in all cases of PR and in 87% of crossover cases. There was no significant difference between the rates of successful reperfusion (53.3% SR, 83% PR, P = 0.20), National Institutes of Health Stroke Scale score on discharge (19 SR, 18 PR group, P = 0.90), or good outcome defined as modified Rankin Scale score 0-2 (13.3% SR, 33.3% PR, P = 0.29).ConclusionsA radial approach can be considered during EVT of AIS due to large vessel occlusion either primarily or secondarily with a lower threshold to switch from the femoral approach in cases of challenging anatomy.Copyright © 2023. Published by Elsevier Inc.

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