7F transradial approach for anterior circulation mechanical thrombectomy: Is it feasible to downsize and maintain consistency?

BackgroundMechanical thrombectomy is the standard of care for acute ischemic stroke due to large vessel occlusion. Choosing a transradial approach (TRA) for anterior circulation occlusions is a matter of debate. The use of a triaxial 7F low-profile system could help mitigate numerous issues related to transradial MT.MethodsFrom 10/2022 to 7/2025, 111 patients underwent TRA-MT for anterior circulation LVOs, both as first-line and as rescue from transfemoral access failure, with the same setup (7F sheath, 7F guide catheter, and aspiration catheters ranging from 062 in. to 043 in. in relation to occlusion site). Choice of thrombectomy technique was at the operator's discretion. Patients' demographic data, clinical presentation, treatment details, complications, rate of TFA crossover, successful reperfusion (mTICI score ≥2b), and good clinical outcome at 3 months (mRS 0-2) were reported.ResultsOf 111 patients, 66 (50%) had occlusion of the M1 MCA, 20 (18%) of the internal carotid artery termination, and 23 (20.7%) of the M2 MCA. Right-sided occlusions were 56/111 (50.5%) and left-sided 56/111 (49.6%). Median patients' age was 80 years, and median NIHSS score was 17 at admission. Successful reperfusion (mTICI ≥2b) was achieved in 103/111 patients (92.8%). Total procedural complication rate was 8/111 (7.2%). No serious access-site complications were reported. Symptomatic ICH occurred in 18/111 (16.2%) patients. Clinical follow-up was available for 104 out of 111 total patients; of them, mRS scores of 0-2 were 54/104 (51.9%)ConclusionsThe high technical effectiveness and good safety profile of this specific tricoaxial setup for TRA-MT in AIS, even for large proximal LVOs, could constitute an optimal alternative to TFA-MT in selected cases.