Efficacy and safety of transradial versus transfemoral access for mechanical thrombectomy in acute ischemic stroke: A systematic review and meta-analysis.
Muhammad Aemaz Ur Rehman, Muhammad Ebaad Ur Rehman, Aqeeb Ur Rehman et al.
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In 30 seconds
This systematic review and meta-analysis compared transradial access (TRA) with transfemoral access (TFA) for mechanical thrombectomy in acute ischemic stroke. It included 14 studies—13 observational studies and one randomized clinical trial—with 4,973 patients. The approaches showed no significant differences in successful or first-pass recanalization, access-to-reperfusion time, favorable functional outcome, mortality, or intracranial hemorrhage. Access-site complications were less frequent with TRA (OR = 0.57; 95% CI 0.37-0.88; p = 0.01). The authors note that randomized comparative evidence remains limited.
Key findings
- Successful recanalization did not differ significantly between TRA and TFA (OR = 0.92; 95% CI 0.66-1.27; p = 0.60).
- First-pass recanalization was not significantly different (OR = 0.84; 95% CI 0.69-1.01, p = 0.06).
- Access-site complications were lower with TRA (OR = 0.57; 95% CI 0.37-0.88; p = 0.01).
- Mortality, intracranial hemorrhage, access-to-reperfusion time, and favorable functional outcome were comparable between groups.
Why it matters
The findings suggest that TRA may offer an alternative route for thrombectomy without an apparent loss of efficacy, while being associated with fewer access-site complications. This comparison is relevant when considering procedural access options, but the evidence base is predominantly observational and does not establish that the approaches are equivalent across all patients or settings.
What to keep in mind
The evidence included 13 observational studies and only one randomized clinical trial, limiting the strength of causal comparisons.