{
  "abstract": "Introduction The transradial approach (TRA) is increasingly used in neurointerventional procedures due to lower access-site complications and improved patient comfort compared with transfemoral access. However, adoption of TRA for complex neurointerventions has been limited by challenges associated with utilizing large-bore catheters/devices, particularly balloon guide catheters (BGCs), which provide proximal flow control and may improve distal embolic protection and procedural efficiency during thrombectomy and other interventions. Sheathless techniques enable insertion of large-bore BGCs (8Fr/0.087-inch class) while minimizing the effective arterial puncture diameter, potentially overcoming radial artery size limitations. Despite growing use of this strategy, its overall safety and feasibility have not been systematically evaluated. We performed a systematic review and meta-analysis to assess procedural success and access-site safety associated with sheathless large-bore BGC utilization via TRA.Methods A systematic search of PubMed, Embase, and Scopus was conducted from database inception through March 2026 for studies reporting neurointerventional procedures performed using sheathless large-bore BGCs via conventional or distal TRA. Eligible studies included case series and comparative cohorts reporting procedural or access-related outcomes. The primary outcome was technical success of sheathless BGC utilization via TRA. Secondary outcomes included crossover to alternative access and access-site hematoma. Pooled proportions were calculated using random-effects models, and heterogeneity was assessed using the I 2 statistic.Results Six studies including 293 procedures were analyzed. The pooled technical success rate of sheathless BGC deployment via TRA was 90% (95% CI 0.79-0.96) with moderate heterogeneity (I 2 = 50.4%). Individual study success rates ranged from 82% to 100%. The pooled crossover rate to alternative access was 7% (95% CI 0-18%), with substantial heterogeneity (I2 = 75.1%). Access-site hematoma occurred in 3% of cases (95% CI 0-13%), also with substantial heterogeneity (I2 = 74.1%). Across included studies, major access-site complications were rare. Variability between studies likely reflects differences in procedural indication, access strategy (conventional versus distal TRA), and operator experience.Conclusion Sheathless deployment of large-bore balloon guide catheters via transradial access appears safe and technically feasible, with high rates of procedural success and low rates of access-site complications. These findings suggest that sheathless BGC strategies may help overcome traditional radial access limitations and facilitate broader use of TRA for complex neurointerventional procedures. Further prospective studies are warranted to better define optimal patient selection and procedural techniques.Disclosures W. Luo: None. W. Lee: None. T. QM Tran: None. R. Correia Maciel: None. A. Dmytriw: None. S. Sheth: None. M. Nahhas: None. E. Raz: None. P. Chen: None. R. Regenhardt: None.Abstract E-232 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Department of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ"
      ],
      "name": "W Luo"
    },
    {
      "affiliations": [
        "Department of Neurology, SUNY Downstate Health Sciences University, New York City, NY"
      ],
      "name": "W Lee"
    },
    {
      "affiliations": [
        "Department of Medicine, Washington University School of Medicine, St. Louis, MO"
      ],
      "name": "T QM Tran"
    },
    {
      "affiliations": [
        "Jundiaí Medical School, São Paulo, Brazil"
      ],
      "name": "R Correia Maciel"
    },
    {
      "affiliations": [
        "Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD"
      ],
      "name": "V Yedavalli"
    },
    {
      "affiliations": [
        "Neuroradiology, Henri Mondor Hospital, Paris, France"
      ],
      "name": "L Scarcia"
    },
    {
      "affiliations": [
        "Neurointerventional & Neuroanalytics Collaboration, Toronto Metropolitan University School of Medicine, Toronto, ON, Canada",
        "Nuffield Department of Surgical Sciences Medical Sciences Division, University of Oxford, Oxford, United Kingdom"
      ],
      "name": "A Dmytriw"
    },
    {
      "affiliations": [
        "Division of Vascular and Interventional Neurology, University of Houston Health Science Center, Houston, TX"
      ],
      "name": "S Sheth"
    },
    {
      "affiliations": [
        "Division of Vascular and Interventional Neurology, University of Houston Health Science Center, Houston, TX"
      ],
      "name": "M Nahhas"
    },
    {
      "affiliations": [
        "Department of Radiology and Neurosurgery, NYU Langone, New York City, NY"
      ],
      "name": "E Raz"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Houston Health Science Center, Houston, TX"
      ],
      "name": "P Chen"
    },
    {
      "affiliations": [
        "Division of Vascular and Interventional Neurology, University of Houston Health Science Center, Houston, TX",
        "Neuroendovascular Program, Massachusetts General Hospital/Harvard Medical School, Boston, MA"
      ],
      "name": "R Regenhardt"
    }
  ],
  "title": "E-232 Safety and feasibility of sheathless large-bore balloon guide catheters via transradial access for neurointerventional procedures: a systematic review and meta-analysis",
  "uid": "44374515-a6a8-5a90-b413-10dd654f5489"
}