Atlantic E Merge

Technicalities – Radial Access

Incorporation of a streamlined, lower-profile catheter setup via TRA could be safe and effective for MT as an upfront modality approach, offering comparably performance to larger-profile platforms typically employed via TFA. This preliminary data suggests that the benefits of TRA approach, notably minimizing access related complications, may be realized without sacrifice in recanalization performance

Mohammad Mahdi Sowlat et al Via Interventional Neuroradiolgy

Initial experience of utilizing a lower-profile transradial approach for mechanical thrombectomy: Comparable efficacy to larger-bore transfemoral approaches
Mohammad Mahdi Sowlat et al Via Interventional Neuroradiolgy

Interv Neuroradiol. 2025 Jun 2:15910199251345031. Online ahead of print. doi: 10.1177/15910199251345031

“…We report our recent institutional experience utilizing TRA as the upfront, default approach in patients with LVO with a streamlined, lower-profile system (7F access sheath, 081 guide catheter, and a 062/043 coaxial aspiration system).

Incorporation of a streamlined, lower-profile catheter setup via TRA could be safe and effective for MT as an upfront modality approach, offering comparably performance to larger-profile platforms typically employed via TFA. This preliminary data suggests that the benefits of TRA approach, notably minimizing access related complications, may be realized without sacrifice in recanalization performance…”

CLINICAL REVIEW

After what it seemed to be an sporadic fever to get the bigger aspiration catheter possible (because the engineer and Pousseuille said so; but also in relation with the excellent comparative results brought by ACE68 and Sofia 6F), a plateau of uncertainty paved the way for the “go big or away” evolution criteria

CONTEXT
As authors state, we are before a retrospective analysis with a small N (23)
Time to recanalization, TICI >2c and FPE being all not just good, but brilliant.

RESULTS
When we contrast our empirical observation we find it easy to agree:safety and efficacy of this radial “small bore” approach is unlikely to be an stadistical artifact, even with a very low N and very favourable operator/center conditions.

CRITICAL ANALYSIS
1. The choice of RADIAL as first approach to “notably minimizing access related complications” can no less than been argued:

a. Despite in most of our centers, and probably specifically in this one, those complications are very likely to be zero, it can always be sustained that femoral complications, even if unlikely, have the potential to be severe.

b. However, it is always good to keep in mind how not oddly radial artery tends to occlude (no less than 5%?); a “minor” complication that still contradicts quite severely our original anatomical design, and so it’s acceptable to assume it might have a higher functional weight in a potentially “cured” patient than the one we tend to balance it against when planning a life/death procedure.
c. Finally, out of perspective in global literature and practice, we find it positive to reinforce the use of radial approach and have it ready for emergencies, first approach or not: the more the number of safe access for the operator the less likely a “proximal” TICI 0 occurs.

Then, we should question about the comparatively scarce literature on direct carotid access, but maybe that’s an interesting topic we might adjurn by now.

2. The BIGGER the better ¿? After what it seemed to be an sporadic fever to get the bigger aspiration catheter possible (because the engineer and Pousseuille said so; but also in relation with the excellent comparative results brought by ACE68 and Sofia 6F), a plateau of uncertainty paved the way for the “go big or away” evolution criteria.

Mantained on the one hand by some bigger options which didn’t really outstand the shelf by their FPE/TICI results or navigability or both (such as VECTA, REACT or even self-competing RED72) and, on the other, by two fierous enemies in the “small leagues”, first CAT6 / Sofia5F ¿? (sorry no experience with the latter) and then quite brutally RED62 later; with the critically contributive fact of ACM2 being standardised in clinical practice as a “no brainer: way to go”, the bigger brothers have spent for years more time in workshops and congresses than in our angio room table.

It might have been too long. Precisely when timid reports started to publicly contradict industry mantained moto for “Bigger”, openly stating the trust-ability of the “smallies” to face quite proximal LVO by the win in track ability and versatility while maintaining aspiration capacities and reducing stress and costs “hugants” (080 and bigger aspiration catheters) have noisily occupied the space of innovation with results that seem to be the next promise to efficacy and simplicity while mantainig great navigability…

We’ll see. At the moment we don’t feel to have the experience or perspective to give a final statement on this discussion. One could preview that, as in life, each size will tend to have its specific case profile and next lap will be brought by transversal technologies such as cyclic aspiration or versatile one stop support-aspiration catheters.

CONCLUSION
Thrilling time we live and love to be Neurointerventionalists:

where sinergies, but also contradictions, in between engineering, comercial, industrial and clinical knowledge should be always be ponderated when discurssing, and more importantly, when making decisions against an specific patient (”Tayloring,Tayloring,Tayloring..”);

and in which production, innovation and clinical practice are close enough for an incredibly fast turn over that allows us to do real time analisys and history for a better understanding and evolution.

Keep the good work! 🙌🏻💪🏻👌🏻👏🏻

Disclaimer/ no comercial disclosures to be made.