ReviewNeuroradiology2025
Feasibility, efficacy, and safety of sheathless transradial mechanical thrombectomy in acute ischemic stroke: A meta-analysis.
Review in Neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
12 authors.
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Abstract
introductionMechanical thrombectomy (MT) is the standard of care for large vessel occlusions (LVO) in acute ischemic stroke (AIS), traditionally performed using transfemoral access (TFA). However, the sheathless transradial approach (sTRA) has emerged as a viable alternative, particularly for patients with complex vascular anatomies.
objectivesThis systematic review and meta-analysis aim to evaluate the feasibility, efficacy, and safety of sTRA in MT for AIS.
methodsWe conducted a systematic review and meta-analysis following PRISMA guidelines, including observational studies that reported on MT using sTRA. Primary outcomes included the proportion of successful reperfusion (modified Treatment in Cerebral Infarction [mTICI] grade 2b-3), crossover rates from radial to femoral access, and symptomatic intracerebral hemorrhage (sICH). Secondary outcomes assessed were minor access site-related complications.
resultsA total of four studies were included, comprising 138 patients who underwent MT with sTRA. The pooled analysis revealed a high rate of successful reperfusion (97%; 95% CI: 95-100%), with a low crossover rate to TFA (3%; 95% CI: 0-7%). The incidence of sICH was low, at 4% (95% CI: 0-8%), and minor access site-related complications occurred in 5% of patients (95% CI: 2-9%).
conclusionThis meta-analysis demonstrates that sTRA is a feasible and effective approach for MT in AIS, with a favorable safety profile. The technique offers high recanalization rates, low complication rates, and minimal need for crossover to TFA. Future randomized controlled trials comparing MT with sTRA and TFA are needed to confirm these results and refine patient selection criteria for this approach. Despite encouraging results, the small number of included studies and their observational design limit the generalizability of the findings. Therefore, further comparative and randomized trials are needed to validate these outcomes.
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