Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
J Neurointerv Surg. 2020 Jan;12(1):82-86. doi: 10.1136/neurintsurg-2019-015145. Epub 2019 Jul 26.
Numerous large randomized trials have shown a significant morbidity and mortality benefit with the transradial approach (TRA) over the transfemoral approach (TFA) for endovascular procedures. However, this technique is routinely avoided or aborted due to unfamiliarity with the technique and the associated anatomical difficulties that may be faced in this approach. The objective of this review is to identify both the common and uncommon challenges that may be encountered during a transradial approach for cerebrovascular catheterization and to provide tips and tricks to overcome the transradial learning curve.
A careful review of the literature and of all our transradial cases was carried out to identify the common challenges and complications that are encountered when using TRA for diagnostic cerebral angiography and neurointerventions.
A stepwise approach is provided to prevent and manage common challenges including radial artery access failure, radial artery spasm, radial artery anomalies and tortuosity, radial artery occlusion, radial artery perforation and hematoma, subclavian tortuosity and anomalies, and catheter knots and kinks.
The ability to recognize and navigate anatomical variations and complications unique to TRA will accelerate learning, decrease unnecessary morbidity and mortality, and further advance the neurovascular field.
大量的大型随机试验表明，与经股动脉入路（TFA）相比，经桡动脉入路（TRA）在血管内介入治疗中具有显著的发病率和死亡率优势。然而，由于对该技术不熟悉以及在该入路中可能遇到的相关解剖学困难，该技术通常被回避或放弃。本综述的目的是确定在经桡动脉入路进行脑血管导管插入术时可能遇到的常见和不常见的挑战，并提供克服经桡动脉学习曲线的技巧和窍门。
仔细复习文献和我们所有的经桡动脉病例，以确定在使用 TRA 进行诊断性脑血管造影和神经介入时遇到的常见挑战和并发症。
提供了一种逐步的方法来预防和处理常见的挑战，包括桡动脉入路失败、桡动脉痉挛、桡动脉异常和迂曲、桡动脉闭塞、桡动脉穿孔和血肿、锁骨下动脉迂曲和异常以及导管结和扭结。
能够识别和导航 TRA 特有的解剖变异和并发症将加速学习过程，降低不必要的发病率和死亡率，并进一步推动神经血管领域的发展。
