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Article

Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry

by
Sabine L. Collette
1,*,
Elke A. van de Ven
2,
Gert-Jan R. Luijckx
2,
Hester F. Lingsma
3,
Pieter Jan van Doormaal
4,
Adriaan C. G. M. van Es
5,
Ido R. van den Wijngaard
6,7,
Robert-Jan B. Goldhoorn
8,
Jan Cees de Groot
1,
Wim H. van Zwam
9,
Charles B. L. M. Majoie
10,
Diederik W. J. Dippel
11,
Reinoud P. H. Bokkers
1,
Maarten Uyttenboogaart
1,2 and
on behalf of the MR CLEAN Registry Investigators
†
1
Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Postbus 30001, 9700 RB Groningen, The Netherlands
2
Department of Neurology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
3
Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
4
Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
5
Department of Radiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
6
Department of Neurology, Haaglanden Medical Center, 2501 CK The Hague, The Netherlands
7
Department of Radiology, Haaglanden Medical Center, 2501 CK The Hague, The Netherlands
8
Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
9
Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
10
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
11
Department of Neurology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
 
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†
See Supplemental File.
J. Clin. Med. 2023, 12(9), 3257; https://doi.org/10.3390/jcm12093257
Submission received: 5 March 2023 / Revised: 13 April 2023 / Accepted: 29 April 2023 / Published: 2 May 2023
(This article belongs to the Special Issue Current Status of Endovascular Therapy for Acute Ischemic Stroke)
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Abstract

Background: Endovascular thrombectomy (EVT) through femoral access is difficult to perform in some patients with acute ischemic stroke due to challenging vasculature. We compared outcomes of EVT through femoral versus alternative arterial access. Methods: In this observational study, we included patients from the MR CLEAN Registry who underwent EVT for acute ischemic stroke in the anterior circulation between 2014 and 2019 in the Netherlands. Patients who underwent EVT through alternative and femoral access were matched on propensity scores in a 1:3 ratio. The primary endpoint was favorable functional outcome (modified Rankin Scale score ≤ 2) at 90 days. Secondary endpoints were early neurologic recovery, mortality, successful intracranial reperfusion and puncture related complications. Results: Of the 5197 included patients, 17 patients underwent EVT through alternative access and were matched to 48 patients who underwent EVT through femoral access. Alternative access was obtained through the common carotid artery (n = 15/17) and brachial artery (n = 2/17). Favorable functional outcome was less often observed after EVT through alternative than femoral access (18% versus 27%; aOR, 0.36; 95% CI, 0.05–2.74). The rate of successful intracranial reperfusion was higher for alternative than femoral access (88% versus 58%), although mortality (59% versus 31%) and puncture related complications (29% versus 0%) were more common after alternative access. Conclusions: EVT through alternative arterial access is rarely performed in the Netherlands and seems to be associated with worse outcomes than standard femoral access. A next step would be to compare the additional value of EVT through alternative arterial access after failure of femoral access.
Keywords: alternative access; brachial artery; carotid artery; endovascular thrombectomy; femoral artery; outcome; radial artery; stroke alternative access; brachial artery; carotid artery; endovascular thrombectomy; femoral artery; outcome; radial artery; stroke

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MDPI and ACS Style

Collette, S.L.; van de Ven, E.A.; Luijckx, G.-J.R.; Lingsma, H.F.; van Doormaal, P.J.; van Es, A.C.G.M.; van den Wijngaard, I.R.; Goldhoorn, R.-J.B.; de Groot, J.C.; van Zwam, W.H.; et al. Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry. J. Clin. Med. 2023, 12, 3257. https://doi.org/10.3390/jcm12093257

AMA Style

Collette SL, van de Ven EA, Luijckx G-JR, Lingsma HF, van Doormaal PJ, van Es ACGM, van den Wijngaard IR, Goldhoorn R-JB, de Groot JC, van Zwam WH, et al. Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry. Journal of Clinical Medicine. 2023; 12(9):3257. https://doi.org/10.3390/jcm12093257

Chicago/Turabian Style

Collette, Sabine L., Elke A. van de Ven, Gert-Jan R. Luijckx, Hester F. Lingsma, Pieter Jan van Doormaal, Adriaan C. G. M. van Es, Ido R. van den Wijngaard, Robert-Jan B. Goldhoorn, Jan Cees de Groot, Wim H. van Zwam, and et al. 2023. "Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry" Journal of Clinical Medicine 12, no. 9: 3257. https://doi.org/10.3390/jcm12093257

APA Style

Collette, S. L., van de Ven, E. A., Luijckx, G.-J. R., Lingsma, H. F., van Doormaal, P. J., van Es, A. C. G. M., van den Wijngaard, I. R., Goldhoorn, R.-J. B., de Groot, J. C., van Zwam, W. H., Majoie, C. B. L. M., Dippel, D. W. J., Bokkers, R. P. H., Uyttenboogaart, M., & on behalf of the MR CLEAN Registry Investigators. (2023). Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry. Journal of Clinical Medicine, 12(9), 3257. https://doi.org/10.3390/jcm12093257

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