Abstract
Mechanical thrombectomy has become the standard of care for acute large vessel occlusion ischemic strokes, with time to reperfusion being the critical factor in determining outcomes. Complex aortic arch and carotid arterial anatomy is associated with increased technical difficulty and thus prolonged procedural times and complication rates. In particular for mechanical thrombectomy, patients with complex aortic arch anatomy and ICA tortuosity are associated with significant increases in puncture-to-reperfusion times. Transradial approach (TRA) from the right subclavian artery offers a technically favorable trajectory in folded over arches and tortuosity and is associated with a greater than 60% reduction in vascular complications, overwhelming patient preference, and reduced post-procedure nursing care, hospital stay, and cost when compared to transfemoral approach. In this chapter, we review the TRA technique for mechanical thrombectomy.