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 Sep;11(9):874-878. doi: 10.1136/neurintsurg-2018-014485. Epub 2019 Jan 22.
A transradial approach (TRA) is associated with fewer access site complications than a transfemoral technique (TFA).However, there is concern that performing mechanical thrombectomy (MT) via TRA may lead to longer revascularization times and thus worse outcomes. Nonetheless, TRA may confer added benefits in MT since navigation of challenging aortic arch and carotid anatomy is often facilitated by a right radial artery trajectory.
To compare outcomes in patients who underwent MT via TRA versus TFA.
We performed a retrospective review of our institutional database to identify 51 patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion between February 2015 and February 2018. Patient characteristics, procedural techniques, and outcomes were recorded. TFA and TRA cohorts were compared.
Of the 51 patients, 18 (35%) underwent MT via TRA. There were no significant cohort differences in patient characteristics, clot location, or aortic arch type and presence of carotid tortuosity. There were no significant differences in outcomes between the two cohorts, including single-pass recanalization rate (54.5% vs 55.6%, p=0.949) and average number of passes (1.9 vs 1.7, p=0.453). Mean access-to-reperfusion time (61.9 vs 61.1 min, p=0.920), successful revascularization rates (Thrombolysis in Cerebral Infarction score ≥2b 87.9% vs 88.9%, p=1.0) and functional outcomes (modified Rankin Scale score≤2, 39.4% vs 33.3%, p=0.669) were similar between TFA and TRA cohorts, respectively.
Our results demonstrate equivalence in efficacy and efficiency between TRA and TFA for MT of anterior circulation large vessel occlusion in patients with challenging vascular anatomy. TRA may be better than TFA in well-selected patients undergoing MT.
与经股动脉技术（TFA）相比，经桡动脉入路（TRA）与较少的入路并发症相关。然而，人们担心通过 TRA 进行机械血栓切除术（MT）可能会导致再通时间延长，从而导致预后更差。尽管如此，TRA 在 MT 中可能会带来额外的好处，因为通过右桡动脉轨迹通常可以更方便地对具有挑战性的主动脉弓和颈动脉解剖结构进行导航。
比较经 TRA 和 TFA 行 MT 的患者的结局。
我们对我院的数据库进行回顾性研究，以确定 2015 年 2 月至 2018 年 2 月期间接受 MT 治疗前循环大血管闭塞的 51 例具有挑战性血管解剖结构的患者。记录患者特征、手术技术和结局。比较 TFA 和 TRA 队列。
51 例患者中，有 18 例（35%）通过 TRA 行 MT。两组患者在患者特征、血栓位置、主动脉弓类型和颈动脉迂曲存在方面无显著差异。两组患者的结局无显著差异，包括单次再通率（54.5% vs 55.6%，p=0.949）和平均通过次数（1.9 次 vs 1.7 次，p=0.453）。平均入路至再通时间（61.9 分钟 vs 61.1 分钟，p=0.920）、成功再通率（血栓切除术治疗脑梗死评分≥2b 87.9% vs 88.9%，p=1.0）和功能结局（改良 Rankin 量表评分≤2 分，39.4% vs 33.3%，p=0.669）在 TFA 和 TRA 组中相似。
我们的研究结果表明，在具有挑战性血管解剖结构的患者中，对于前循环大血管闭塞的 MT，TRA 与 TFA 的疗效和效率相当。在经过精心选择的接受 MT 的患者中，TRA 可能优于 TFA。
