Transradial Access Results in Faster Recanalization in Left Anterior Circulation Stroke with Bovine Arch Anatomy.

Background: We compared technical and clinical outcomes of transradial (TRA) versus transfemoral (TFA) access for mechanical thrombectomy of acute ischemic stroke due to large vessel occlusion in the left anterior cerebral circulation of bovine origin. Methods: A single-center retrospective review of a prospectively maintained neurointerventional database from a large volume service in a tertiary academic center. Procedural metrics, technical, and clinical outcomes data were collected and analyzed for patients who underwent mechanical thrombectomy presenting with acute ischemic stroke and large vessel occlusion in the left anterior circulation of bovine origin. Clinical and procedural outcomes included the average number of passes, single first effective pass, rate of successful recanalization (thrombolysis in cerebral infarction score≥2b), 3-month disability modified Rankin scale scores, time from skin puncture to microcatheter placement, and recanalization. Results: Between January 2018 and January 2021, 26 patients (TRA=13, TFA=13) underwent mechanical thrombectomy. The TRA cohort had a significantly shorter time in minutes for skin puncture to microcatheter placement (TRA: 17.0±5.8 versus TFA: 35.4±20.5; P=0.0001), shorter skin puncture to recanalization (TRA: 34.0±15.6 versus TFA: 58.1±34.6; P=0.01), and shorter total fluoroscopy time (TRA: 13.8±9.4 versus TFA: 29.5±18.0; P=0.03). The 3-month modified Rankin scale score of (0-1) was higher in the TRA group (38.5% versus 7.69%; P=0.06). Conclusions: In patients with large vessel occlusion in the left anterior cerebral circulation of bovine origin, right TRA access permits more direct navigation and provides a stable platform resulting in shorter procedure times and faster recanalization with potential for improved functional outcomes.