Gao Feng, Lo WaiTing Joyce, Sun Xuan, Ma Ning, Mo DaPeng, Xu XiaoTong, Miao ZhongRong
Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Diseases, 6 Tiantan Xili, Dongcheng District, Beijing 100050, China; Center of Stroke, Beijing Institute for Brain Disorders, 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
Clin Neurol Neurosurg. 2015 Jul;134:116-21. doi: 10.1016/j.clineuro.2015.04.015. Epub 2015 Apr 29.
To study the feasibility and safety of transradial artery access for endovascular intervention of severe intracranial vertebrobasilar stenosis for selected patients not suitable for transfemoral access.
This was a retrospective analysis of 58 patients who had undergone intervention for severe intracranial vertebrobasilar stenosis using transradial access between January 2012 and September 2014. The reasons for transradial access were traced. The outcome measures were the technical success rate, 30-day stroke or death in the territory of the culprit artery, periprocedural and access site complication rates.
Out of the 58 patients, 19 patients (32.8%) used the transradial approach due to poor iliofemoral artery access, 28 (48.3%) due to unfavorable brachiocephalic or subclavian artery anatomy, 11 (19%) due to unfavorable vertebral artery anatomy. The technical success rate was 100%. There were four periprocedural complications, one of which was asymptomatic. The 30-day stroke rate was 5.2% (3/58 patients), with two of them having no residual neurological deficits. There was no mortality. None had access site complications.
For selected patients with severe intracranial vertebrobasilar stenosis with difficult femoral access or anatomical variations precluding provision of a stable support for intracranial intervention, the transradial approach was shown to be a safe and feasible alternative route of access. Future trials of endovascular treatment for intracranial posterior circulation strokes should take into account the route of access.
研究经桡动脉途径对部分不适合经股动脉途径的严重颅内椎基底动脉狭窄患者进行血管内介入治疗的可行性和安全性。
对2012年1月至2014年9月期间采用经桡动脉途径对严重颅内椎基底动脉狭窄进行介入治疗的58例患者进行回顾性分析。追溯采用经桡动脉途径的原因。观察指标包括技术成功率、责任动脉供血区30天内的卒中或死亡率、围手术期及穿刺部位并发症发生率。
58例患者中，19例（32.8%）因髂股动脉入路不佳采用经桡动脉途径，28例（48.3%）因头臂干或锁骨下动脉解剖结构不佳，11例（19%）因椎动脉解剖结构不佳。技术成功率为100%。围手术期有4例并发症，其中1例无症状。30天卒中率为5.2%（58例患者中有3例），其中2例无残留神经功能缺损。无死亡病例。无一例发生穿刺部位并发症。
对于部分严重颅内椎基底动脉狭窄且股动脉入路困难或存在解剖变异而无法为颅内介入提供稳定支撑的患者，经桡动脉途径是一种安全可行的替代入路。未来颅内后循环卒中血管内治疗试验应考虑入路途径。
