Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
J Neurointerv Surg. 2020 Oct;12(10):993-998. doi: 10.1136/neurintsurg-2019-015642. Epub 2020 Jan 22.
Interventional cardiology produced level 1 evidence recommending radial artery-first for coronary angiography given lower vascular complications. Neuroendovascular surgeons have not widely adopted the transradial approach. This prospective, single center, non-inferiority comparative effectiveness study aims to compare the transradial and transfemoral approaches for diagnostic cerebral angiography with respect to efficacy, safety and patient satisfaction.
Consecutive patients presenting for diagnostic cerebral angiography were selected to undergo right radial or femoral access based on date of presentation. Primary outcome was ability to answer the predefined diagnostic goal of the cerebral angiogram using the initial access site and was assessed with a non-inferiority design. Secondary outcomes included technical success per vessel, complications, procedure times and patient satisfaction.
A total of 312 patients were enrolled, 158 and 154 for right radial and femoral access, respectively. The diagnostic goal of the angiogram was achieved in 152 of 154 (99%) patients who underwent attempted femoral access compared with 153 of 158 (97%) patients who underwent radial access, confirming non-inferiority of the transradial approach. Secondary outcomes showed equivalent technical success by vessel, no major complications, and similar frequency of minor complications between the two approaches. In-room time was similar between approaches, though post-procedure recovery room time was significantly shorter for transradial patients. Patient satisfaction results significantly favored the radial approach.
In patients undergoing diagnostic cerebral angiography, transfemoral and transradial access achieve procedural goals with similar effectiveness and safety, though patients strongly prefer the radial approach. Findings support consideration of adopting a radial-first strategy for diagnostic cerebral angiography.
介入心脏病学产生了 1 级证据，建议首选桡动脉进行冠状动脉造影，因为桡动脉的血管并发症较低。神经介入外科医生尚未广泛采用经桡动脉入路。这项前瞻性、单中心、非劣效性比较有效性研究旨在比较经桡动脉和经股动脉入路进行诊断性脑血管造影术在疗效、安全性和患者满意度方面的差异。
连续选择因就诊日期而选择行右桡动脉或股动脉入路的患者进行诊断性脑血管造影。主要结局是使用初始入路部位能否达到脑血管造影的预先设定的诊断目标，采用非劣效性设计进行评估。次要结局包括每支血管的技术成功率、并发症、手术时间和患者满意度。
共纳入 312 例患者，分别有 158 例和 154 例患者行右桡动脉和股动脉入路。与 154 例（99%）尝试行股动脉入路的患者相比，158 例（97%）行桡动脉入路的患者的血管造影诊断目标均得到了实现，证实了经桡动脉入路的非劣效性。次要结局显示，两种入路的血管技术成功率相当，无重大并发症，且轻微并发症的发生率相似。两种入路的手术室内时间相似，但桡动脉入路患者术后恢复室时间明显缩短。患者满意度结果明显偏向桡动脉入路。
在接受诊断性脑血管造影的患者中，经股动脉和经桡动脉入路在达到治疗目标方面具有相似的效果和安全性，但患者强烈倾向于桡动脉入路。研究结果支持考虑采用桡动脉优先策略进行诊断性脑血管造影术。
