Abstract DP078: Transradial versus Transfemoral Endovascular Thrombectomy for Posterior Circulation Large Vessel Occlusion: A prospective multicenter study

Background: Acute posterior circulation large vessel occlusion (LVO) carries high risks of mortality and disability. Transradial artery (TRA) access may offer anatomical advantages over transfemoral artery (TFA) access for thrombectomy in posterior circulation LVO. We compared the safety and efficacy of TRA versus TFA thrombectomy in these patients. Methods: In this multicenter prospective cohort study, patients with acute posterior circulation LVO undergoing thrombectomy (January 2022–September 2024) were categorized by primary access site (TRA vs. TFA). The primary endpoint was 90-day good neurological recovery (modified Rankin Scale [mRS] 0–2). Secondary endpoints included mRS distribution, successful revascularization (mTICI ≥ 2b), puncture-to-recanalization time, and hospital stay length. Safety outcomes comprised puncture-site complications, symptomatic intracranial hemorrhage, and mortality. Multivariable regression models were used for analysis. Results: Among 379 patients, 83 (21.9%) underwent TRA thrombectomy. No significant differences were observed in 90-day good neurological recovery (TRA 48% vs. TFA 41.4%; aOR 1.19, 95% CI 0.70–2.03, P = 0.518), mRS distribution (aOR 1.03, 95% CI 0.63–1.68, P = 0.919), or successful recanalization rates (97.6% vs. 93.2%; aOR 4.44, 95% CI 0.50–38.7, P = 0.181). TRA was associated with shorter puncture-to-recanalization time (44 [32–73] vs. 59 [34–88] min, P = 0.026) and hospital stay (7 [5–11] vs. 9 [6–15] days, P < 0.001). Safety outcomes did not differ between groups. Conclusion: For posterior circulation LVO, TRA thrombectomy demonstrated comparable safety and efficacy to TFA, with faster recanalization and shorter hospitalization.