Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, Florida, USA.
J Neurointerv Surg. 2019 Aug;11(8):796-800. doi: 10.1136/neurintsurg-2018-014620. Epub 2019 Jan 22.
The transradial approach (TRA) to endovascular procedures decreases access site morbidity and mortality in comparison with the traditional transfemoral technique (TFA). Despite its improved safety profile, there is a concern that TRA is less favorable for neurointerventional procedures that require large coaxial systems to manage the small tortuous cerebral vessels.
To report our experience with TRA for flow diverter placement for treatment of unruptured cerebral aneurysms.
We performed a retrospective review of prospective institutional databases at two high-volume centers to identify 49 patients who underwent flow diversion for aneurysm treatment via primary TRA between November 2016 and November 2018. Patient demographics, procedural techniques, and clinical data were recorded.
Of the 49 patients, 39 underwent successful flow diversion placement by TRA. Ten patients were converted to TFA after attempted TRA. There were no procedural complications. Reasons for failure included tortuosity in eight patients and severe radial artery spasm in two.
In the largest reported series to date of flow diverter deployment via TRA for aneurysm treatment, we demonstrate the technical feasibility and safety of the method. The most common reason for failure of TRA was an acute angle of left common carotid artery origin or left internal carotid artery tortuosity. Overall, our data suggest that increasing adoption of TRA is merited given its apparent equivalence to the current TFA technique and its documented reduction in access site complications.
与传统的经股动脉技术（TFA）相比，经桡动脉入路（TRA）可降低血管内介入治疗的穿刺部位发病率和死亡率。尽管其安全性得到了改善，但人们担心TRA 不利于需要大同轴系统来处理小而迂曲的脑动脉的神经介入手术。
报告我们使用 TRA 进行血流导向装置放置治疗未破裂脑动脉瘤的经验。
我们对两个高容量中心的前瞻性机构数据库进行了回顾性分析，以确定 49 例于 2016 年 11 月至 2018 年 11 月期间通过原发性 TRA 进行血流导向装置放置治疗的患者。记录患者的人口统计学、手术技术和临床数据。
在 49 例患者中，39 例通过 TRA 成功进行了血流导向装置放置。10 例患者在尝试 TRA 后转为 TFA。无手术并发症。失败的原因包括 8 例患者的迂曲和 2 例严重的桡动脉痉挛。
在迄今为止报道的最大系列 TRA 治疗动脉瘤的血流导向装置放置中，我们证明了该方法的技术可行性和安全性。TRA 失败的最常见原因是左侧颈总动脉起源或左侧颈内动脉迂曲的锐角。总体而言，我们的数据表明，鉴于 TRA 与当前的 TFA 技术相当，并且其记录的穿刺部位并发症减少，越来越多地采用 TRA 是合理的。
