Deans' stroke musings: Radial Versus Femoral Access for Mechanical Thrombectomy in Stroke Patients: A Non-Inferiority Randomized Clinical Trial

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, February 3, 2024

Radial Versus Femoral Access for Mechanical Thrombectomy in Stroke Patients: A Non-Inferiority Randomized Clinical Trial

Useless research. NO MEASUREMENT OF 100% RECOVERY! I'd fire you all.

Successful recanalization is only the first step to recovery, if you have nothing after that you're completely incompetent!

Radial Versus Femoral Access for Mechanical Thrombectomy in Stroke Patients: A Non-Inferiority Randomized Clinical Trial

David Hernandez,

Manuel Requena,

Marta Olivé Gadea,

Marta De Dios Lascuevas,

Laura Ludovica Gramegna,

Marian Muchada,

Álvaro García-Tornel,

Francesco Diana,

… See all authors

Originally published1 Feb 2024https://doi.org/10.1161/STROKEAHA.124.046360Stroke. 2024;0

Abstract

Background: Transfemoral access is predominantly used for mechanical thrombectomy in stroke patients with a large vessel occlusion. Following the interventional cardiology guidelines, routine transradial access has been proposed as an alternative, although its safety and efficacy remain controversial. We aim to explore the non-inferiority of radial access in terms of final recanalization.

Methods: The study was an investigator-initiated, single-center, evaluator-blinded randomized clinical trial. Stroke patients undergoing mechanical thrombectomy, with a patent femoral artery and a radial artery diameter ≥2.5mm, were randomly assigned (1:1) to either transradial (60 patients) or transfemoral access (60 patients). The primary binary outcome was the successful recanalization (eTICI 2b-3) assigned by blinded evaluators. We established a non-inferiority margin of -13.2%, considering an acceptable reduction of 15% in the expected recanalization rates.

Results:From September 2021 to July 2023, 120 patients were randomly assigned and 116 (58 transradial access, 58 transfemoral access) with confirmed intracranial occlusion on the initial angiogram were included in the intention-to-treat analysis. Successful recanalization(NOT GOOD ENOUGH!) was achieved in 51 (87.9%) patients assigned to transfemoral access and in 56/58 (96.6%) patients assigned to transradial (adjusted one side risk difference -5.0% (95% CI, -6.61% to +13.1%) showing non-inferiority of transradial access. Median time from angiosuite arrival to first pass (femoral: 30 (IQR 25-37) minutes versus radial: 41 (IQR 33-62) minutes, p<0.001) and from angiosuite arrival to recanalization (femoral: 42 (IQR 28-74) versus radial: 59.5 (IQR 44-81) minutes, p<0.050) were longer in the transradial access group. Both groups presented one severe access complication and there was no difference in the rate of access conversion: transradial 7 (12.1%) versus transfemoral 5 (8.6%) (p=0.751).

Conclusion: Among patients who underwent mechanical thrombectomy, transradial access was non-inferior to transfemoral access in terms of final recanalization. Procedural delays may favor transfemoral access as the default firstline approach.