Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
School of Medicine, Lebanese American University, Beirut, Lebanon.
J Neurointerv Surg. 2020 Dec;12(12):1235-1241. doi: 10.1136/neurintsurg-2020-016140. Epub 2020 Aug 7.
The transradial approach (TRA) reduces mortality, morbidity, access site complications, hospital cost, and length of stay while maximizing patient satisfaction. We aimed to assess the technical success and safety of TRA for elderly patients (aged ≥75 years).
A retrospective chart review and comparative analysis was performed for elderly patients undergoing a diagnostic cerebral angiogram performed via TRA versus transfemoral approach (TFA). Also, a second comparative analysis was performed among the TRA cohort between elderly patients and their younger counterparts.
Comparative analysis in the elderly (TRA vs TFA) showed no significant differences for contrast dose per vessel (43.7 vs 34.6 mL, P=0.106), fluoroscopy time per vessel (5.7 vs 5.2 min, P=0.849), procedure duration (59.8 vs 65.2 min, P=0.057), conversion rate (5.8% vs 2.9%, P=0.650), and access site complications (2.3% vs 2.9%, P=1.00). Radiation exposure per vessel (18.9 vs 51.9 Gy cm, P=0.001) was significantly lower in the elderly TRA group.The second comparison (TRA in elderly vs TRA in the young) showed no significant differences for contrast dose per vessel (43.7 vs 37.8 mL, P=0.185), radiation exposure per vessel (18.9 vs 16.5 Gy cm, P=0.507), procedure duration (59.8 vs 58.3 min, P=0.788), access site complication (2.3% vs 1.7%, P=0.55), and conversation rate (5.8% vs 1.8%, P=0.092). A trend for prolonged fluoroscopy time per vessel (5.7 vs 4.7 min, P=0.050) was observed in the elderly TRA group.
TRA is a technically feasible and safe option for diagnostic neurointerventional procedures in the elderly. Our small elderly cohort was not powered enough to show a significant difference in terms of access site complications between TRA and TFA.
经桡动脉入路（TRA）降低了死亡率、发病率、入路部位并发症、住院费用和住院时间，同时最大限度地提高了患者满意度。我们旨在评估 TRA 用于老年患者（年龄≥75 岁）的技术成功率和安全性。
对经 TRA 与经股动脉入路（TFA）行诊断性脑动脉造影的老年患者进行回顾性图表审查和对比分析。此外，还对 TRA 队列中的老年患者与年轻患者进行了第二次对比分析。
TRA 与 TFA 在老年患者中的对比分析显示，每支血管的造影剂剂量（43.7 与 34.6mL，P=0.106）、每支血管的透视时间（5.7 与 5.2min，P=0.849）、手术时间（59.8 与 65.2min，P=0.057）、转化率（5.8%与 2.9%，P=0.650）和入路部位并发症（2.3%与 2.9%，P=1.00）无显著差异。每支血管的辐射暴露量（18.9 与 51.9Gycm，P=0.001）显著降低TRA 组的老年患者较低。第二次比较（TRA 中的老年患者与 TRA 中的年轻患者）显示，每支血管的造影剂剂量（43.7 与 37.8mL，P=0.185）、每支血管的辐射暴露量（18.9 与 16.5Gycm，P=0.507）、手术时间（59.8 与 58.3min，P=0.788）、入路部位并发症（2.3%与 1.7%，P=0.55）和转化率（5.8%与 1.8%，P=0.092）无显著差异。TRA 组的透视时间每支血管延长的趋势（5.7 与 4.7min，P=0.050）。
TRA 是一种在老年患者中进行诊断性神经介入治疗的可行且安全的选择。我们的老年小队列样本量不足以显示 TRA 与 TFA 之间在入路部位并发症方面的显著差异。
