Transradial Access as an Innovative Approach for Endovascular Thrombectomy: A Living Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Endovascular thrombectomy (EVT) is the standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Transradial access (TRA) has emerged as an alternative to traditional transfemoral access (TFA), showing promise in reducing access-site complications. This systematic review and meta-analysis aim to comprehensively assess the procedural and clinical outcomes of TRA versus TFA for EVT in AIS-LVO patients. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched electronic databases for studies comparing TRA and TFA in EVT. Eligible studies, comprising 2138 patients, were analyzed for outcomes, including successful and complete recanalization, favorable functional outcomes [modified Rankin Scale (mRS) 0-2), access-to-perfusion time, first-pass reperfusion, mean number of passes, and complications. Risk of bias was assessed using the Newcastle-Ottawa Scale and Risk of Bias Assessment tool-2. Both TRA and TFA groups demonstrated comparable rates of successful recanalization, complete recanalization, and favorable functional outcomes at 90 days. Procedural metrics, including first-pass reperfusion, mean number of passes, and access-to-perfusion time, showed no statistically significant differences between the 2 approaches. TRA exhibited fewer access-site complications, but rates of symptomatic intracranial hemorrhage were similar. This meta-analysis suggests that TRA is a safe and non-inferior alternative to TFA for EVT in AIS-LVO patients, potentially reducing access-site complications. However, caution is needed due to the observational nature of most studies. Future randomized trials are essential to provide robust evidence for the comparative efficacy of TRA and TFA, addressing anatomical variations and procedural nuances.
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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 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.036 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".