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Abstract Number â 156: Transradial versus Transfemoral Access for Mechanical Thrombectomy: A MetaâAnalysis of Nine Studies (2,161 Patients)
Introduction Previous studies have compared the transradial access (TRA) with the transfemoral access (TFA) in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We conducted this metaâanalysis to provide comprehensive evidence regarding the comparison of procedural and clinical outcomes of the TRA versus the TFA in AIS patients undergoing MT. Methods We performed a comprehensive literature search of four electronic databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL) from inception until 1 May 2022. All duplicates were removed, and all references of the included studies were screened manually for any eligible studies. The fullâtext articles of eligible abstracts were retrieved and screened for continued eligibility. Relevant data were extracted and then analyzed. For outcomes that constitute continuous data, the mean difference (MD) between the two groups and its standard deviation (SD) were pooled. For outcomes that constitute dichotomous data, the frequency of events and the total number of patients in each group were pooled as odds ratio (OR) between the two groups. Results Nine studies were included in this metaâanalysis, all of which were observational studies. The population of the studies was homogenous comprising a total of 2,161 patients who underwent MT, including 446 in the TRA group and 1,715 in the TFA group. There were no significant differences across the two groups in terms of successful recanalization (Thrombolysis in cerebral Infarction [TICI] score of 2bâ3: OR 0.83, 95% CI [0.55 to 1.25], PÂ =Â 0.36) (Figure 1, A), complete recanalization (TICI 3: OR 1.16, 95% CI [0.50 to 2.68], PÂ =Â 0.73), favorable functional outcome (90âday modified Rankin scale [mRS] score of 0â2 (OR 0.86, 95% CI [0.53 to 1.41], PÂ =Â 0.56), firstâpass reperfusion (OR 0.88, 95% CI [0.64 to 1.19], PÂ =Â 0.41), number of passes (MD 0.12, 95% CI [â0.18 to 0.42], PÂ =Â 0.43) (Figure 1, B), accessâtoâreperfusion time (MD â3.92 minutes, 95% CI [â9.49 to 1.65], PÂ =Â 0.17), the amount of contrast used (MD 5.03 mL, 95% CI [â20.27 to 30.33], PÂ =Â 0.70), or symptomatic intracranial hemorrhage (OR 0.86, 95% CI [0.47 to 1.57], PÂ =Â 0.62). However, accessâsite complications were significantly less frequent in the TRA group as compared to the TFA group (OR 0.18, 95% CI [0.06 to 0.51], PÂ =Â 0.001) (Finger 1, C). Conclusions In patients undergoing MT for AIS, the collective evidence suggests that the TRA seems to result in lower rates of accessâsite complications than the TFA without any significant compromise in other clinical or procedural metrics. Large prospective studies are warranted