{
  "abstract": "Introduction/Purpose Recently, trans-radial access (TRA) has gained popularity in neurointervention, demonstrating non-inferiority to trans-femoral access (TFA). We sought to evaluate the efficacy of a TRA-first approach to stroke thrombectomy and identify patient factors that may predict the need for conversion to TFA.Materials and Methods We performed retrospective chart review of all anterior circulation thrombectomies performed by a single surgeon (VN) since adoption of a TRA-first protocol in late 2024. We identified presenting factors including demographics, vascular comorbidities, and occlusion location. Occlusions up to the MCA bifurcation were considered proximal and all others distal. Intake CTAs were assessed for arch anatomy, including right subclavian artery (SCA) height above the arch, maximal left common carotid artery (CCA) diameter, CCA turnoff angle from the innominate artery (IA), IA-CCA distance along the arch, and the presence of curves (≤120°) in the SCA-IA. Each case was classified as either TRA- or TFA-first. In the case of conversion from TRA to TFA, conversion reason was determined by chart review. Our primary outcome was conversion from TRA to TFA. Secondary outcomes were number of passes, first pass effect (FPE), final TICI, time from first puncture to recanalization (punc2TICI), access site complications, hemorrhagic transformation, and 90-day functional independence (mRS≤2). Continuous and dichotomous variables were compared between groups with rank-sum and Barnard’s exact tests, respectively.Results We identified 50 anterior circulation thrombectomies, with 36 performed TRA-first and 14 TFA-first. Among TRA-first cases, 8 (22.2%) required conversion. Reasons for conversion were difficult left ICA access (4), radial anatomy (3), and guide-catheter upsizing (1). All converted cases were left-sided occlusions. Converted cases were significantly older than TRA-only (median 79.5 versus 71.5 years, p=0.048). Among those converted for non-radial reasons, 2 (40%) were distal occlusions and 3 (60%) were proximal. Comparing all left-sided TRA-only cases (15) to cases converted for ICA access (3 of 4 had CTA available), increased SCA height (median of 67.1mm versus 52.6mm, p=0.01) and IA-CCA distance ≥4.25cm (100% versus 26.7%, p=0.01) were significantly associated with conversion. Decreased CCA turnoff trended toward association with conversion (median of 12.5° versus 34.5°, p=0.056). CCA diameter (median of 9.5mm versus 7.3mm, p=0.35) and incidence of SCA-IA curve (100% versus 80%, p=0.32) were not significantly different. TRA-first cases (including converted cases) were significantly more likely to experience FPE (50% versus 21.4%, p=0.04) and final TICI 2b+ (97.2% versus 71.4%, p=0.04) when compared to TFA-first cases. There was no difference between TRA-first and TFA-first cases in incidence of distal occlusions (38.9% versus 14.3%, p=0.055), number of passes (median of 1 versus 2, p=0.41), punc2TICI time (median of 27 versus 26 minutes, p=0.66), access site complications (5.6% versus 4.5%, p=0.81, all minor), HI1+hemorrhagic transformation (41.7% versus 35.7%, p=0.37), or 90-day functional independence (47.2% versus 35.7%, p=0.32).Conclusion A TRA-first approach is feasible in the majority of stroke thrombectomy cases and is associated with higher rates of FPE and TICI 2b+ recanalization and equivalent functional outcomes compared to TFA-first cases. In this series, increased age, SCA height, and IA-CCA distance are significant risk factors for conversion.Disclosures M. Cotroneo: None. T. Mungara: None. K. Pellot: None. G. Kohli: None. V. Nguyen: None.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY"
      ],
      "name": "M Cotroneo"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY"
      ],
      "name": "T Mungara"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY"
      ],
      "name": "K Pellot"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY"
      ],
      "name": "G Kohli"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY"
      ],
      "name": "V Nguyen"
    }
  ],
  "title": "E-286 Radial-first stroke thrombectomy: feasibility, conversion predictors, and outcomes",
  "uid": "e8819541-4a07-54b9-aba2-0b9885f7f7ec"
}