Jo Kwang Wook, Park Sung Man, Kim Sang Don, Kim Seong Rim, Baik Min Woo, Kim Young Woo
Department of Neurosurgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea.
J Korean Neurosurg Soc. 2010 May;47(5):332-7. doi: 10.3340/jkns.2010.47.5.332. Epub 2010 May 31.
Although a transradial angiography is accepted as the gold standard for cardiovascular procedures, cerebral angiography has been performed via transfemoral approach in most institutions. The purpose of this study is to present our experience concerning the feasibility, efficacy, and safety of a transradial approach to cerebral angiography as an alternative to a transfemoral approach.
Between February 2007 and October 2009, a total of 1,240 cerebral angiographies were performed via a transradial approach in a single center. The right radial approach was used as an initial access route. The procedure continued only after the ulnar artery was proven to provide satisfactory collateral perfusion according to two tests (a modified Allen's test and forearm angiography).
The procedural success rate was 94.8% with a mean duration of 28 minutes. All supra-aortic vessels were successfully catheterized with a success rate of 100%. The success rates of selective catheterization to the right vertebral artery, right internal carotid artery, left internal carotid artery, and left vertebral artery were 96.1%, 98.6%, 82.6% and 52.2%, respectively. The procedure was performed more than twice in 73 patients (5.9%), including up to 4 times in 2 patients. The radial artery occlusion was found in 4 patients (5.4%) on follow-up cerebral angiography, but no ischemic symptoms were observed in any of the cases.
This study suggests that cerebral angiography using a transradial approach can be performed with minimal risk of morbidity. In particular, this procedure might be useful for follow-up angiographies and place less stress on patients.
尽管经桡动脉血管造影被公认为心血管介入手术的金标准，但在大多数机构中，脑血管造影仍通过经股动脉途径进行。本研究的目的是介绍我们关于经桡动脉途径进行脑血管造影作为经股动脉途径替代方法的可行性、有效性和安全性的经验。
2007年2月至2009年10月期间，在单一中心共进行了1240例经桡动脉途径的脑血管造影。右桡动脉途径作为初始入路。只有在根据两项检查（改良艾伦试验和前臂血管造影）证明尺动脉能提供满意的侧支灌注后，手术才继续进行。
手术成功率为94.8%，平均持续时间为28分钟。所有主动脉弓血管均成功插管，成功率为100%。选择性插管至右椎动脉、右颈内动脉、左颈内动脉和左椎动脉的成功率分别为96.1%、98.6%、82.6%和52.2%。73例患者（5.9%）进行了超过两次的手术，其中2例患者进行了多达4次的手术。随访脑血管造影发现4例患者（5.4%）出现桡动脉闭塞，但所有病例均未观察到缺血症状。
本研究表明，经桡动脉途径进行脑血管造影的发病风险极小。特别是，该手术可能对随访血管造影有用，且对患者的压力较小。
