• Ryota Kimura, Ichiro Nakagawa, Kenji Fukutome, Hisashi Kawai, Yoshinari Okumura, and Hiroyuki Nakase.
• Department of Neurosurgery, Seikeikai General Hospital, Osaka, Japan. Electronic address: r-kimura@seikeikai.or.jp.
• World Neurosurg. 2020 Aug 1; 140: e266-e272.

ObjectiveA 9-French (Fr) sheath is routinely used during mechanical thrombectomy (MT) for treating acute ischemic stroke (AIS). However, the use of a large sheath is a risk factor for access site complications (ASCs). Previous studies focused on preventing intracranial complications, and only a few have explored ASCs. We investigated the technical feasibility and efficacy of a sheathless procedure for AIS (SPAIS) that uses a 9-Fr balloon-guiding catheter as a guiding sheath to reduce the sheath size and prevent ASCs during MT.MethodsWe retrospectively analyzed the data of 133 patients who underwent MT at our center. Patients treated between January 2015 and August 2017 received conventional treatment (C) using a 9-Fr sheath, and SPAIS was attempted in patients treated between September 2017 and October 2019. We first assessed the technical feasibility of SPAIS, and subsequently compared the incidence of ASCs between the SPAIS and C groups. Routine postsurgical ASC assessments using duplex ultrasonography were performed during the post-MT bed-rest period.ResultsThe technical success rate of SPAIS was 97.6% (81 of 83 patients). The incidence of ASCs was significantly lower in the SPAIS group (2 of 81, 2.5%) than in the C group (7 of 52, 13.4%) (P < 0.05). Moreover, developed pseudoaneurysms in the SPAIS group showed significantly faster hemostasis than those in the C group (mean 20 minutes vs. 32 minutes; P < 0.05).ConclusionsSPAIS is a feasible technique that effectively reduces MT-associated ASCs; thus, this approach should be adopted to improve patient outcomes.Copyright © 2020 Elsevier Inc. All rights reserved.

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