Transcarotid Access for Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis and Systematic Review |
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| Affiliation: | 1. New York Medical College School of Medicine, Valhalla, NY, USA;2. Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA;3. Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA;1. Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States;2. Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States;3. Division of Cardiology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, United States;1. Department of Functional Pathology, School of Medicine, Shimane University, Izumo 693-8501, Japan;2. Institute of Animal Experiment, Shimane University, Izumo 693-8501, Japan;3. Central Clinical Laboratory, Shimane University Hospital. Izumo 693-8501, Japan;4. Department of Chemistry and Biotechnology, Graduate School of Engineering, Tottori University, Tottori 680-8552, Japan;1. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States;2. Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, United States;3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States;4. Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States;5. Department of Radiology, Mayo Clinic, Rochester, Minnesota;6. Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States;7. Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States;8. Department of Medicine: The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi, United States;9. Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States;10. Department of Neurology, University of Minnesota, Minneapolis, Minnesota, United States;11. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States;1. School of Rehabilitation Sciences, Population Health Research Institute (PHRI), McMaster University, Hamilton, Canada;2. Biostatistics Consultant, St. Catharines, Canada;3. Department of Medicine (Neurology), PHRI/ McMaster University / Hamilton Health Sciences (HHS), Hamilton, Canada;4. National University Ireland - Galway, Galway, Ireland;5. Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom;6. International Clinical Research Centre and Department of Neurology, St. Anne''s University Hospital and Medical Facility of Masaryk University, Brno, Czech Republic;7. Bayer AG, Wuppertal, Germany;8. PHRI/McMaster University/ HHS, Hamilton, Canada;9. HRB-Clinical Research Facility, National University Ireland - Galway, Galway, Ireland;1. Department of Clinical Biochemistry, Shiraz University of Medical Sciences, Shiraz, Iran;2. Department of Clinical Biochemistry, Hamadan University of Medical Sciences, Hamadan, Iran;3. Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran;4. Shahid Beheshti Educational and Medical Center, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran;5. Department of Neurology, Sina (Farshchian) Educational and Medical Center, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran;6. Department of Neurology, Faculty of Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran |
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| Abstract: | ObjectivesDespite the success of mechanical thrombectomy in large vessel acute ischemic stroke, recanalization may fail due to difficult anatomic access or peripheral arterial occlusive disease. In these cases, transcarotid access may be used as an alternative, but it has not gained prominence due to safety concerns. Our objective was to assess the efficacy and safety of transcarotid access for mechanical thrombectomy.Materials and MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform a systematic review with articles published from 2010 to 2020 summarizing pre-intervention characteristics, techniques utilized, and outcomes of patients undergoing mechanical thrombectomy via trans-carotid puncture. We performed a meta-analysis of clinical outcomes, reperfusion times and overall complications rates of trans-carotid approach.ResultsSix studies describing 80 total attempts at carotid access, 72 of which were successful (90% success rate), were included. Direct carotid puncture was most often used as a rescue technique (87% of patients) secondary to failed femoral access. Successful recanalization was achieved in 76% of patients. 90 day modified Rankin Scale ≤ 2 was achieved in 28% of patients. Carotid puncture-reperfusion time was 32 min (CI = 24–40, p < 0.001). Cervical complications occurred at a rate of 26.5% (95% CI = 17%–38%). Only 1.3% (1/80 patients) had a fatal outcome and 96% of complications required no intervention.ConclusionsOur results on the safety and efficacy of transcarotid access suggests that this approach is a viable alternative to failed thrombectomy when transfemoral or trans-radial access may be impractical. |
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