Levy Elad I, Boulos Alan S, Fessler Richard D, Bendok Bernard R, Ringer Andrew J, Kim Stanley H, Qureshi Adnan I, Guterman Lee R, Hopkins L Nelson
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York (SUNY Buffalo), USA.
Neurosurgery. 2002 Aug;51(2):335-40; discussion 340-2.
The transradial approach has been well described for arteriography of the coronary vessels. To assess the safety and success rate of the transradial approach for three-vessel or four-vessel diagnostic cerebral arteriography, we reviewed the experience at our institution and compared our complication rates with those found in the literature for transfemoral cerebral angiography and transradial coronary angiography.
We reviewed the electronic medical records of 129 consecutive patients in whom 132 cerebral angiographic studies were performed by use of a transradial approach between December 1999 and June 2001. A total of 54 selective catheterizations were performed, of which 39 were of the vertebral artery, 11 of the internal carotid artery, and 4 of the external carotid artery. Records were reviewed for periprocedural and delayed complications, indications for diagnostic angiography, and requirement of conversion to a femoral approach. Records were reviewed prospectively for the first 55 procedures and retrospectively for the next 77 procedures.
The mean time to initial clinical follow-up was 1.5 months (median, 0.5 mo). The combined rate of periprocedural and delayed complications was 9%, and there were no major complications. Minor periprocedural complications included transient radial artery spasm (four patients), failure to access the brachial artery (two patients), severe pain (one patient), skin desquamation (one patient), and hematoma (one patient). There were no major complications. At the time of follow-up evaluation, these patients were without deficits related to cannulation of the radial artery.
The transradial approach for cerebral angiography is a safe alternative to the transfemoral route. After transradial cerebral angiography, patients require a shorter observation period and are not restricted to bed rest. As technological developments generate smaller, more pliable endovascular surgical devices, future endovascular surgery may be performed transradially.
经桡动脉途径已被充分描述用于冠状动脉血管造影。为评估经桡动脉途径用于三血管或四血管诊断性脑动脉造影的安全性和成功率，我们回顾了我们机构的经验，并将我们的并发症发生率与文献中经股动脉脑动脉造影和经桡动脉冠状动脉造影的并发症发生率进行了比较。
我们回顾了1999年12月至2001年6月期间连续129例患者的电子病历，这些患者采用经桡动脉途径进行了132次脑动脉造影研究。共进行了54次选择性导管插入术，其中39次是椎动脉，11次是颈内动脉，4次是颈外动脉。回顾记录以查找围手术期和延迟并发症、诊断性血管造影的适应症以及转为股动脉途径的需求。对前55例手术进行前瞻性记录回顾，对接下来的77例手术进行回顾性记录回顾。
首次临床随访的平均时间为1.5个月（中位数，0.5个月）。围手术期和延迟并发症的综合发生率为9%，无重大并发症。轻微的围手术期并发症包括短暂性桡动脉痉挛（4例患者）、未能进入肱动脉（2例患者）、严重疼痛（1例患者）、皮肤脱屑（1例患者）和血肿（1例患者）。无重大并发症。在随访评估时，这些患者没有与桡动脉插管相关的缺陷。
经桡动脉途径进行脑动脉造影是经股动脉途径的一种安全替代方法。经桡动脉脑动脉造影后，患者需要的观察期较短，且不受卧床休息的限制。随着技术的发展产生更小、更柔韧的血管内手术器械，未来的血管内手术可能经桡动脉进行。
