2025 American Academy of Neurology Abstract Website

Ocilio Goncalves¹, Victor Arthur Ohannesian², Henrique Maia³, Marina Vilardo⁴, Luis Paleare⁵, Christian Fukunaga⁶, João Victor Araújo de Oliveira¹, Tarsis Mendes¹, Marcio Ferreira⁷, Kelson Almeida¹, João Paulo Telles⁸
¹Department of Medicine, Federal University of Piauí, ²Faculty of Medicine, Albert Einstein Israeli Faculty of Health Sciences (FICSAE), ³Faculty of Medicine, Estácio de Sá University Cittá (IDOMED), ⁴Faculty of Medicine, Catholic University of Brasilia, ⁵Faculty of Medicine, Pontifical Catholic University of Paraná, ⁶Deparment of Medicine, FMABC University Center, ⁷Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, ⁸Department of Neurology, University of São Paulo

Objective:

This systematic review and meta-analysis aim to evaluate the feasibility, efficacy, and safety of sheathless transradial approach (sTRA) in mechanical thrombectomy (MT) for acute ischemic stroke (AIS).

Background:

MT is the standard of care for large vessel occlusions (LVO) in AIS, traditionally performed using transfemoral access (TFA). However, the sTRA has emerged as a viable alternative, particularly for patients with complex vascular anatomies.

Design/Methods:

We conducted a systematic review and meta-analysis following PRISMA guidelines, including observational studies that reported on MT using sTRA. Primary outcomes included the proportion of successful reperfusion (modified Treatment in Cerebral Infarction [mTICI] grade 2b-3), crossover rates from radial to femoral access, and symptomatic intracerebral hemorrhage (sICH). Secondary outcomes assessed were minor access site-related complications.

Results:

A total of four studies were included, comprising 138 patients who underwent MT with sTRA. The pooled analysis revealed a high rate of successful reperfusion (97%; 95% CI: 95-100%), with a low crossover rate to TFA (3%; 95% CI: 0-7%). The incidence of sICH was low, at 4% (95% CI: 0-8%), and minor access site-related complications occurred in 5% of patients (95% CI: 2-9%).

Conclusions:

This meta-analysis demonstrates that sTRA is a feasible and effective approach for MT in AIS, with a favorable safety profile. The technique offers high recanalization rates, low complication rates, and minimal need for crossover to TFA. Future randomized controlled trials comparing MT with sTRA and TFA are needed to confirm these results and refine patient selection criteria for this approach.