Objective To compare transradial artery access (TRA) to the gold standard of transfemoral artery access (TFA) in mechanical thrombectomy (MT) for stroke caused by anterior circulation large vessel occlusion. Methods The clinical outcomes, procedural speed, angiographic efficacy and safety of both techniques were analysed in 375 consecutive cases over an 18-month period in a high volume statewide neurointerventional service. Results There was no significant difference in patient characteristics, stroke parameters, imaging techniques or intracranial techniques. The median time elapsed between CT scanning and reperfusion was 96.5 min (IQR 68–123) in the TFA group and 95 min (IQR 68–123) in the TRA group (p=0.456). Of 336 patients who were independent at presentation 58% (124/214) of the TFA group and 67% (82/122) of the TRA group had a modified Rankin score of 0–2 at 90-day follow-up (p=0.093). Cross-over from radial to femoral was 4.6% (4/130) compared with 1.6% cross-over from femoral to radial (4/245), but did not meet the predetermined level of statistical significance (OR 2.92, 95% CI 0.81 to 10.52), p=0.088) and did not impact median procedural speed. Adequate angiographic reperfusion, first pass reperfusion, embolisation to new territory and symptomatic intracranial haemorrhage were similar in both groups. There was a significant difference in major access site complications requiring an additional procedure. None of the TRA cases had a major access site complication but 6.5% (16/245) of the TFA cases did (p=0.003). Conclusion This study suggests that using TRA for anterior circulation MT is fast, efficacious, safe and not inferior to the gold standard of TFA. Deidentified participant data may be available from the corresponding author on reasonable request, subject to permission from the local ethics board.

中文翻译：

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经桡动脉与经股动脉通路用于前循环机械血栓切除术：对 375 例连续病例的分析

目的比较经桡动脉通路（TRA）与经股动脉通路（TFA）在前循环大血管闭塞所致卒中机械取栓术（MT）中的金标准。方法 在为期 18 个月的大规模全州神经介入服务中，对 375 例连续病例分析了两种技术的临床结果、手术速度、血管造影效果和安全性。结果 患者特征、卒中参数、成像技术或颅内技术无显着差异。TFA 组 CT 扫描和再灌注之间经过的中位时间为 96.5 分钟（IQR 68-123），TRA 组为 95 分钟（IQR 68-123）（p=0.456）。在就诊时独立的 336 名患者中，58% (124/214) 的 TFA 组和 67% (82/122) 的 TRA 组在 90 天随访时改良 Rankin 评分为 0-2（p= 0.093)。从桡骨到股骨的交叉率为 4.6% (4/130)，而从股骨到桡骨的交叉率为 1.6% (4/245)，但未达到预定的统计学显着性水平 (OR 2.92, 95% CI 0.81到 10.52），p=0.088）并且不影响中位程序速度。两组的充分血管造影再灌注、首次再灌注、新区域栓塞和症状性颅内出血相似。需要额外手术的主要通路部位并发症存在显着差异。没有 TRA 病例有主要的进入部位并发症，但 6.5% (16/245) 的 TFA 病例有 (p=0.003)。结论 本研究提示使用 TRA 进行前循环 MT 快速、有效、安全且不逊于 TFA 的金标准。经当地伦理委员会许可，可根据合理要求从通讯作者处获得身份不明的参与者数据。