Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
J Neurointerv Surg. 2021 Jun;13(6):547-551. doi: 10.1136/neurintsurg-2020-016564. Epub 2020 Aug 25.
Many neurointerventionalists have transitioned to transradial access (TRA) as the preferred approach for neurointerventions as studies continue to demonstrate fewer access site complications than transfemoral access. However, radial artery spasm (RAS) remains one of the most commonly cited reasons for access site conversions. We discuss the benefits, techniques, and indications for using the long radial sheath in RAS and present our experience after implementing a protocol for routine use.
A retrospective review of all patients undergoing neurointerventions via TRA at our institution from July 2018 to April 2020 was performed. In November 2019, we implemented a long radial sheath protocol to address RAS. Patient demographics, RAS rates, radial artery diameter, and access site conversions were compared before and after the introduction of the protocol.
747 diagnostic cerebral angiograms and neurointerventional procedures in which TRA was attempted as the primary access site were identified; 247 were performed after the introduction of the long radial sheath protocol. No significant differences in age, gender, procedure type, sheath sizes, and radial artery diameter were seen between the two cohorts. Radial anomalies and small radial diameters were more frequently seen in patients with RAS. Patients with clinically significant RAS more often required access site conversion (p<0.0001), and in our multivariable model use of the long sheath was the only covariate protective against radial failure (OR 0.061, 95% CI 0.007 to 0.517; p=0.0103).
In our experience, we have found that the use of long radial sheaths significantly reduces the need for access site conversions in patients with RAS during cerebral angiography and neurointerventions.
许多神经介入医师已经将经桡动脉入路（TRA）作为神经介入的首选方法，因为研究继续表明，与经股动脉入路相比，TRA 的入路部位并发症更少。然而，桡动脉痉挛（RAS）仍然是最常被引用的入路部位转换原因之一。我们讨论了在 RAS 中使用长桡动脉鞘的益处、技术和适应证，并介绍了在实施常规使用方案后的经验。
回顾性分析了 2018 年 7 月至 2020 年 4 月期间在我院行 TRA 的所有神经介入患者。2019 年 11 月，我们实施了长桡动脉鞘方案来解决 RAS。比较了该方案引入前后患者的人口统计学特征、RAS 发生率、桡动脉直径和入路部位转换。
共确定了 747 例经 TRA 作为主要入路尝试的诊断性脑血管造影和神经介入手术，其中 247 例在引入长桡动脉鞘方案后进行。两组患者的年龄、性别、手术类型、鞘管大小和桡动脉直径无显著差异。RAS 患者更常出现桡动脉异常和桡动脉直径较小。临床显著 RAS 患者更常需要入路部位转换（p<0.0001），在多变量模型中，长鞘的使用是唯一保护桡动脉不失败的因素（OR 0.061，95%CI 0.007 至 0.517；p=0.0103）。
根据我们的经验，我们发现在脑血管造影和神经介入中，使用长桡动脉鞘可显著降低 RAS 患者的入路部位转换需求。
