Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Pediatric Endocrinology, Children Hospital of Philadelphia, Philadelphia, PA, USA.
Neuroradiology. 2021 Aug;63(8):1335-1343. doi: 10.1007/s00234-021-02672-4. Epub 2021 Feb 9.
Data in neurointerventional literature is extremely limited regarding the safety and efficacy of flow diversion using transradial access (TRA). We aim to demonstrate the safety and efficacy of intracranial aneurysm treatment with the Pipeline Embolization Device (PED) using TRA compared to transfemoral access (TFA).
We conducted a retrospective analysis of a prospectively maintained database and identified 79 consecutive patients who underwent neuroendovascular embolization for cerebral aneurysms using the PED from April 2018 through October 2019. Patients were divided into 2 groups: TRA (32 patients) and TFA (47 patients). A comparative analysis was performed between the two groups.
There was no significant difference in postoperative intracranial hemorrhage (p>.99), symptomatic ischemic stroke (p=.512), access site complications (p=.268), or other complications (p=.512). However, there was a significant increase in overall complications (14.9% vs. 0.0%, p=.038) and procedure duration (71.4 min ± 31.2 vs. 58.5 ± 20.3, p=.018) in the TFA group. There was no significant difference in complete occlusion at latest follow-up (19/25, 76.0% vs. 35/40, 87.5%; p=.311), 6-month follow-up (17/23, 73.9% vs. 33/38, 86.8%; p=.303), or 12-month follow-up (8/8, 100.0% vs. 5/6, 83.3%; p=.429). There was also no significant difference in rate of retreatment (p>.99), morbidity (p=.512), mortality (p>.99), latest follow-up (p=.985), or loss of follow-up (p=.298).
The feasibility and efficacy of flow diversion with the PED via TRA for the treatment of intracranial aneurysms is comparable to TFA. Widespread adoption of this approach may be facilitated by improvements in device navigation and manipulation via radial-specific engineering.
神经介入文献中关于经桡动脉入路（TRA）应用血流导向装置（PED）治疗的安全性和有效性的数据极为有限。我们旨在证明与经股动脉入路（TFA）相比，使用 TRA 治疗颅内动脉瘤的安全性和有效性。
我们对前瞻性维护的数据库进行了回顾性分析，共纳入 2018 年 4 月至 2019 年 10 月期间 79 例使用 PED 行神经血管内栓塞治疗颅内动脉瘤的连续患者。将患者分为 TRA 组（32 例）和 TFA 组（47 例），对两组进行比较分析。
两组患者术后颅内出血（p>.99）、症状性缺血性卒中（p=.512）、入路部位并发症（p=.268）或其他并发症（p=.512）差异均无统计学意义。然而，TFA 组总并发症（14.9% vs. 0.0%，p=.038）和手术时间（71.4 min ± 31.2 vs. 58.5 ± 20.3，p=.018）明显增加。在末次随访时完全闭塞率（19/25，76.0% vs. 35/40，87.5%；p=.311）、6 个月随访（17/23，73.9% vs. 33/38，86.8%；p=.303）和 12 个月随访（8/8，100.0% vs. 5/6，83.3%；p=.429）差异均无统计学意义。再治疗率（p>.99）、发病率（p=.512）、死亡率（p>.99）、末次随访（p=.985）和失访率（p=.298）差异均无统计学意义。
经桡动脉入路应用 PED 治疗颅内动脉瘤的可行性和有效性与 TFA 相当。通过径向特定工程改进设备导航和操作，可能会更广泛地采用这种方法。
