Radial access mechanical thrombectomy: A case series

Mahrukh Rehman Khan

Abstract

    The Journal of Neuropsychiatry 2020 Vol.4No.1     Radial access mechanical thrombectomy: A case series Mahrukh Rehman Khan, Zafar Hashim, Jawad Ahmad Royal Stoke University Hospital     Abstract Cardiologists have been preferentially using Trans-radial access (TRA) for many years now and have demonstrated its safety in comparison to trans-femoral access (TFA). The uptake of TRA by neurointerventionalists has been slow but recent literature has shown that it is safe. In our centre we have started using TRA for neurovascular procedures and here we present our initial experience with three cases of mechanical thrombectomy: Case 1: 58-year-old male presenting with sudden onset left-sided neck pain, with left arm weakness, dizziness and vomiting. CTA showed left vertebral artery dissection with basilar artery occlusive thrombus. Access achieved through the right radial artery and successful recanalization achieved with a single pass. Case 2: 75-year-old male, with sudden onset collapse following intermittent dizziness and left arm weakness throughout the day. Initial CT head showed no abnormalities. Overnight GCS dropped to 4/15, with up going plantars and fixed dilated left pupil. Repeat CT/CTA showed bilateral thalamic infarcts, left cerebellar infarct and basilar artery thrombus. Thrombectomy performed with right radial artery access, successful recanalization with single pass. Case 3: 45 year old male with sudden onset hemianopia and confusion. CTA showed left proximal PCA thrombus. Right radial access used to perform thrombectomy, successful recanalization with single pass. Conclusion and Significance-All the above procedures were performed with no significant time delay in comparison to TFA. Further, there were no complications. Our initial experience has demonstrated that mechanical thrombectomy via TRA can be performed safely, effectively and with few access site complications, where anatomical and procedural considerations allow     References: Chen SH, Snelling BM, Sur S, et al. Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes. Journal of NeuroInterventional Surgery 2019;11:874-878. Furlan AB, Joshi KC, Munich SA. Radial access for acute stroke thrombectomy: The case for using transradial access in neurointervention. Endovascular Today 2020;19(2):66-68. Sur S, Snelling BM, Khandelwal P et al. Transradial approach for mechanical thrombectomy in anterior circulation large-vessel occlusion. Neurosurg Focus 2017;42:1-4. Khanna O, Mouchtouris N, Sweid A, et al Transradial approach for acute stroke intervention: technical procedure and clinical outcomes. Stroke and Vascular Neurology 2020;5:doi: 10.1136/svn-2019-000263 Mizokami T, Uwatoko T, Furukawa T et al. Transradial approach for mechanical thrombectomy of posterior circulation stroke. Journal of neuroendovascular therapy 2018;12:314-319. Oselkin M, Satti SR, Sundararajan SH et al. Endovascular treatment for acute basilar thrombosis via a transradial approach: Initial experience and future consideration. Interventional Neuroradiology 2018; 24(1): 64–69. Bottom Note: This abstract has been taken from the conference world neuroscience dated on 27th May 2020               ISSN2471-8548                             The Journal of Neuropsychiatry         Volume4,Issue1           Page-8