Matsumoto Y, Hongo K, Toriyama T, Nagashima H, Kobayashi S
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
AJNR Am J Neuroradiol. 2001 Apr;22(4):704-8.
Diagnostic selective cerebral angiography is commonly performed via transfemoral and transbrachial approaches. With these approaches, however, patients occasionally suffer serious complications. The purpose of this study was to evaluate the feasibility, efficacy, and safety of a transradial approach as an alternative to the transfemoral and transbrachial approaches.
Between October 1998 and September 1999, transradial cerebral angiography was performed in 166 consecutive patients in a single center as a diagnostic procedure. Before the procedure, we confirmed the collateral blood supply to the hand from the ulnar artery using a modified Allen test. Regular catheterization techniques were practiced using our newly designed 120-cm-long 4F catheter. In 42 patients, anticoagulant and/or antiplatelet therapy was given perioperatively.
Twelve of the 166 patients proved to be poor candidates for the transradial approach, owing to restlessness (n = 9), lack of collateral blood supply via the ulnar artery (n = 2), and brachial artery stenosis (n = 1). The radial artery was successfully punctured and cannulated in the remaining 154 patients. Selective catheterization of the intended vessels was obtained in all carotid and vertebral angiographic procedures with no major vascular complications.
Compared with transfemoral and transbrachial approaches, the transradial approach is a less invasive and safer technique for selective cerebral angiography and may warrant consideration as a standard procedure. Anticoagulant or antiplatelet therapy need not be discontinued for this method.
诊断性选择性脑血管造影术通常经股动脉和肱动脉途径进行。然而，采用这些途径时，患者偶尔会出现严重并发症。本研究的目的是评估经桡动脉途径作为股动脉和肱动脉途径替代方法的可行性、有效性和安全性。
1998年10月至1999年9月期间，在单一中心对166例连续患者进行了经桡动脉脑血管造影术作为诊断性操作。在操作前，我们使用改良的艾伦试验确认了尺动脉对手部的侧支血供。使用我们新设计的120厘米长的4F导管练习常规插管技术。42例患者在围手术期接受了抗凝和/或抗血小板治疗。
166例患者中有12例因躁动（n = 9）、尺动脉缺乏侧支血供（n = 2）和肱动脉狭窄（n = 1）而被证明不适合经桡动脉途径。其余154例患者的桡动脉成功穿刺并插管。在所有颈动脉和椎动脉血管造影操作中均成功进行了目标血管的选择性插管，未出现重大血管并发症。
与股动脉和肱动脉途径相比，经桡动脉途径对于选择性脑血管造影术是一种侵入性较小且更安全的技术，可能值得作为标准操作加以考虑。采用这种方法无需停用抗凝或抗血小板治疗。
