Transradial Access as an Innovative Approach for Endovascular Thrombectomy: A Living Systematic Review and Meta-Analysis

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.