The efficacy of mechanical thrombectomy via right brachial approach for hyperacute right anterior circulation infarction

Background Mechanical thrombectomy (MT) is a well-established treatment for acute large-vessel occlusion. While the transfemoral approach (TFA) is the standard, it can be challenging in elderly patients with tortuous vasculature. The transbrachial approach (TBA) offers a shorter and more direct route but is associated with more puncture site complications. This study investigates the effectiveness and feasibility of TBA for right anterior circulation strokes. Methods A total of 23 patients who underwent MT via TBA between September 2023 and January 2025 were retrospectively analyzed and compared with 23 patients treated via TFA from March 2021 to April 2023. Patient characteristics, procedural times, recanalization rates, and complications were evaluated. Results The TBA group showed a shorter median puncture-to-guiding (PtoG) time (13 vs 16 min) and puncture-to-recanalization (PtoR) time (37 vs 52 min) compared to the TFA group. Successful recanalization (TICI ≥2b) was achieved in 95.7% of TBA cases versus 87.0% in TFA. One minor puncture site complication occurred in the TBA group. In rare instances, catheter kinking at the subclavian–CCA junction was observed. Sheathless technique was employed in most TBA cases to minimize puncture complications. Conclusion TBA is a feasible alternative for MT in right anterior circulation strokes, providing improved procedural efficiency. While associated with a higher rate of puncture complications, TBA offers a practical solution in cases where TFA or TRA may be technically challenging.