Abstract 4144305: Comparison of Transradial Versus Transfemoral Access in Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background and Purpose: Transfemoral access (TFA) has been the standard for neuro-interventional procedures, but it carries risks such as pseudoaneurysm formation and arterial occlusion. Transradial access (TRA) is a newer alternative that may reduce these complications. This study aims to compare the clinical outcomes of TRA versus TFA in mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Databases searched included PubMed/MEDLINE, Cochrane Library, and Google Scholar up to April 7, 2024. A random-effects model was used for analysis, and study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias (RoB 2) tool. Results: The search identified 1389 records, and 13 studies (12 observational, 1 RCT) with 4803 patients (TRA: 855, TFA: 3948) were included. TRA showed no significant difference in successful recanalization (TICI 2b-3) compared to TFA [RR: 0.98; 95% CI: 0.94 – 1.03]. Complete recanalization (TICI 3) was also similar [RR: 1.08; 95% CI: 0.96 – 1.21]. Fluoroscopy time, reported by four studies, showed no significant difference [RR: -1.76; 95% CI: -7.54 – 4.02]. Hospital stay duration from three studies was comparable [MD: -0.52; 95% CI: -1.25 – 0.21]. The access-to-perfusion time reported by ten studies showed no significant difference [MD: -1.70; 95% CI: -8.11 – 4.72]. The mean number of passes from eight studies showed no significant difference [MD: 0.10; 95% CI: -0.06 – 0.27]. Procedural complications were lower in the TRA group but not statistically significant [6.09% vs. 8.77%, RR: 0.71; 95% CI: 0.46 – 1.09]. TRA had significantly fewer access site complications [RR: 0.23; 95% CI: 0.08 – 0.62]. Symptomatic intracranial hemorrhage from seven studies showed no significant difference [RR: 1.0; 95% CI: 0.72 – 1.38]. NIHSS score at discharge showed no significant difference [MD: 1.31; 95% CI: -2.14 – 4.76]. In-hospital mortality from two studies showed no significant difference [RR: 0.56; 95% CI: 0.26 – 1.20]. Ninety-day mortality from three studies showed no significant difference [RR: 1.15; 95% CI: 0.98 – 1.36]. Conclusion: TRA is as effective as TFA for MT in AIS and significantly reduces the risk of access site complications. Further large-scale RCTs are warranted to confirm these findings and refine the clinical guidelines for optimal access strategy in neuro-interventional procedures.
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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 | 0.010 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.022 | 0.039 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
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".