Safety and Efficacy of Radial Versus Femoral Artery Access for Mechanical Thrombectomy Procedures Following Intravenous Administration of Tissue Plasminogen Activator

Abstract

Background The transradial artery (TRA) approach for neuroendovascular procedures is a safe and effective alternative to the transfemoral artery (TFA) approach. We compared the efficiency and periprocedural outcomes of TRA and TFA approaches for acute stroke interventions in patients receiving intravenous tissue plasminogen activator. Methods A retrospective cohort study analyzed data from patients at a large cerebrovascular center from January 1, 2014, to March 31, 2021. Baseline characteristics, periprocedural efficiency and efficacy, and in‐hospital outcomes were compared between intervention cohorts (TRA and TFA). Results Of 314 patients analyzed, 21 (7%) underwent a TRA approach and 293 (93%) underwent a TFA approach. Complications occurred in one (5%) of 21 patients in the TRA cohort and 20 (7%) of 293 patients in the TFA cohort. Access site complications were present in 12 (4%) patients with TFA, and no patients with TRA experienced access site complications. The mean length of stay was significantly longer for the TFA cohort (8.8 days [standard deviation, 8.5 days]) versus the TRA cohort (4.8 days [standard deviation, 2.9 days]) ( P =0.02). Linear regression analysis showed that femoral access, Medicaid insurance, and discharge National Institutes of Health Stroke Scale score >10 predicted longer length of stay ( P ≤0.046). However, when the time to initial physical or occupational therapy session was added to the model, access site was no longer significant ( P =0.42). Conclusion The TRA approach may reduce periprocedural complications and hospital length of stay compared with the TFA approach. The shorter length of stay associated with TRA access appeared to be associated with earlier initiation of physical or occupational therapies.