E-122 The feasibility and efficacy of trans-radial access for mechanical thrombectomy in ischemic stroke: a systematic review of the literature
Bibliographic record
Abstract
Background/Purpose The use of the radial artery to access the cervical and cerebral arteries is gaining popularity in the neuro-interventional field. This trans-radial approach (TRA) avoids the tortuosity that could be encountered in the aortic arch thereby shortening procedural times. This could be relevant in stroke endovascular thrombectomy procedures where time is critical. Large randomized controlled trials of coronary interventions have demonstrated that a TRA is associated with better outcomes and fewer access site complications than trans-femoral access (TFA). We conducted a systematic review to assess the safety and potential advantages of TRA for mechanical thrombectomy in adults with ischemic stroke. Materials and methods We conducted a Medline search of the literature, including studies published in full in the English language with ≥5 adult patients with acute ischemic stroke reporting on the procedures, success, and complications of TRA (± TFA). Clinical and procedural variables were extracted and tabulated. Results Sixty-eight studied were screened and five met our inclusion criteria. All studies were retrospective and conducted in the United States of America. A total of 73 patients with acute ischemic stroke underwent mechanical thrombectomy (median age 79 years, median initial NIHSS 18). In two studies, TFA was initially attempted but failed. Only one study included a TFA comparison group (n=33 patients). Mean access to reperfusion time was 76.3±36.0 minutes (median 61.1, range 35.8–132 minutes) in TRA vs. 54.0±29.0 minutes (median 54.0, range 46-–62 minutes) in TFA. Successful reperfusion (Thrombolysis in Cerebra Infarction score [TICI] ≥2b) was reported in 89% of the patients. Failure to reach the target occlusion was reported in 9% of TRA cases. Conclusion TRA shows promising efficacy and efficiency for endovascular thrombectomy. Some of the available literature mostly reflects TRA use as a rescue access after failure to obtain TFA resulting in delaying reperfusion. Whether the routine use of TRA will result in comparable reperfusion rates to TFA and faster time to reperfusion is to be shown. Future studies on the TRA in stroke need to separately report the results of learning-phase cases and rescue TRA access. Disclosures A. Kuczynski: None. M. Goyal: None. M. Almekhlafi: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.033 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.006 |
| Bibliometrics | 0.018 | 0.018 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.014 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".