Abstract TP299: Transradial Access Without Radial Cocktail for Mechanical Thrombectomy is Safe and Feasible

Introduction: Transradial access requires the use of an intra-arterial infusion of a combination of vasodilators and heparin (radial cocktail) to reduce the incidence of arterial occlusion or vasospasm. However, both medications can have a potential deleterious effect on the collateral circulation and increase the risk of post-procedural hemorrhagic transformation. Hypothesis: Acute clot extraction has become a relatively fast procedure with short procedural time (from skin puncture to reperfusion) potentially making the use of radial cocktail unnecessary. Methods: We conducted a single center retrospective cohort study of the patients with acute proximal large vessel occlusion, who received mechanical thrombectomy via transradial/transulnar access from February 2018-July 2025.The primary exposure was radial cocktail was given during the procedure. Three groups are divided: full dose cocktail (Heparin 2000 units, Verapamil 2.5mg, and Nitroglycerin 200mg), half dose cocktail (Heparin 1000 units or none, Verapamil 2.5mg, and Nitroglycerin 200mg) and none cocktail. The primary outcome was the incidence of clinically symptomatic radial/ulnar artery occlusion or vasospasm at discharge. The secondary outcome includes hemorrhagic transformation rate on 24hrs CT head, and the procedure time with fluoroscopy. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), controlling for age, gender, preprocedural administration of intravenous thrombolysis and the access sheath size. Results: Of 270 patients (age 69.65 ± 14., 71% male, n = 192), 230 cases were via radial artery (85.2%). Full dose was given in 110 case (40.7%), 41 with half dose and 118 (43.7%) without cocktail. Only 15 patients (5.5%) received thrombolytic prior procedure. Seven French sheath was used in 232 (85.9%) patients, 8 French in 17 cases and 5 French in 21 procedures. There is no clinically symptomatic radial/ulnar artery occlusion or vasospasm at discharge in three groups. The hemorrhagic transformation rate and the procedure time with fluoroscopy were not associated with administration of cocktail. Conclusions: In the modern era of mechanical thrombectomy the fast procedural time may make the need of intra-arterial radial cocktail unnecessary during transradial access. These findings should be corroborated with a larger prospective multicenter data.