Transradial Versus Transfemoral Access for Mechanical Thrombectomy in Acute Ischemic Stroke: An Update Meta-Analysis and Trial Sequential Analysis

作者：Anuraag Punukollu, Leonardo B. O. Brenner, Pedro Henrique Carvalho Leite Romeiro, Aishwarya Koppanatham, Sávio Batista, Raphael Bertani, Eberval Gadelha Figueiredo, Daniel Dutra Cavalcanti · 发表于：Neurosurgery · 年份：2025 · DOI：10.1227/neu.0000000000003467 · 被引用次数：4 · 研究领域：Vascular Procedures and Complications、Central Venous Catheters and Hemodialysis、Peripheral Artery Disease Management

BACKGROUND AND OBJECTIVE: Transfemoral access (TFA) is the standard for mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Transradial access (TRA) is a feasible alternative. Despite advances, no recent systematic review or meta-analysis exists, highlighting the need for updated evidence. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases were searched up to February 2024 for articles comparing TRA with TFA for MT in AIS. Studies were included if they reported at least one outcome, with at least 10 patients per group. Random-effects models were applied, with odds ratios (ORs) used for dichotomous outcomes and mean differences (MDs) for continuous outcomes. RESULTS: Our analysis included 763 TRA patients and 3527 TFA patients, with one randomized study and nine observational studies. We found no significant differences in successful recanalization (OR 0.88, 95% CI: 0.59-1.32), complete recanalization (OR 1.15, 95% CI: 0.92-1.43), first pass effect (OR 0.83, 95% CI: 0.68-1.01), puncture-to-recanalization time (MD -1.67, 95% CI: -7.48 to 4.13), access site complications (OR 0.70, 95% CI: 0.28-1.76), symptomatic intracranial hemorrhage (OR 0.93, 95% CI: 0.62-1.39), crossover (OR 1.71, 95% CI: 0.75-3.92), number of passes (MD 0.17, 95% CI: -0.08-0.41), length of hospitalization (MD -0.59, 95% CI: -1.28-0.09), and favorable outcomes at 3 months (OR 0.85, 95% CI: 0.58-1.23). Trial sequential analysis showed that succ...