Feasibility and Safety of a Novel 4 Fr Sheath Transradial and Transbrachial Approach for Mechanical Thrombectomy in Selected Patients.

The transradial/transbrachial approach for mechanical thrombectomy offers potential reductions in access-site complications, but the feasibility of downsizing to a 4 Fr guiding sheath remains to be systematically assessed. To evaluate the feasibility and safety of mechanical thrombectomy performed through a 4 Fr transradial/transbrachial approach in selected patients and to compare procedural metrics with those of a contemporaneous transfemoral approach cohort treated at the same center, we retrospectively reviewed consecutive patients who underwent mechanical thrombectomy between December 2023 and December 2024. Overall, 17 patients were treated with a 4 Fr sheath through the right transradial/transbrachial approach and 87 with transfemoral approach. Baseline demographics, procedural times, recanalization rates, and access-site complications were compared using the Mann-Whitney U or χ2 tests, as appropriate. Successful recanalization (modified Thrombolysis in Cerebral Infarction grade ≥ 2b) was achieved in 14 of 17 cases (82%) in the 4 Fr group, comparable to 78 of 87 cases (90%) in the transfemoral approach group (p = 0.39). Median puncture-to-recanalization time was 34 min (interquartile range 27.8-67) versus 36 min (interquartile range 23-56.5) (p = 0.78). No symptomatic intracranial hemorrhage occurred in the 4 Fr cohort. Access-site complications were limited to 1 minor superficial hematoma (6%), whereas the transfemoral approach group experienced 3 access-site events (3.4%), all pseudoaneurysms. A 4 Fr transradial/transbrachial approach for mechanical thrombectomy is feasible and indicates a favorable safety profile without prolonging procedure time in carefully selected right-sided or posterior circulation lesions with low thrombus burden. Larger prospective studies are warranted to confirm these signals and to explore applicability to broader patient populations.