Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA.
Oper Neurosurg (Hagerstown). 2021 Jun 15;21(1):E3-E7. doi: 10.1093/ons/opab018.
The transradial access (TRA) is rapidly gaining popularity for neuroendovascular procedures as there is strong evidence for its benefits compared to the traditional transfemoral access (TFA). However, the transition to TRA bears some challenges including optimization of the interventional suite set-up and workflow as well as its impact on fellowship training.
To compare the learning curves of TFA and TRA for diagnostic cerebral angiograms in neuroendovascular fellowship training.
We prospectively collected diagnostic angiogram procedural data on the performance of 2 neuroendovascular fellows with no prior endovascular experience who trained at our institution from July 2018 until June 2019. Metrics for operator proficiency were minutes of fluoroscopy time, procedure time, and volume of contrast used.
A total of 293 diagnostic angiograms were included in the analysis. Of those, 57.7% were TRA and 42.3% were TFA. The median contrast dose was 60 cc, and the median radiation dose was 14 000 μGy. The overall complication rate was 1.4% consisting of 2 groin hematomas, 1 wrist hematoma, and 1 access-site infection using TFA. The crossover rate to TFA was 2.1%. Proficiency was achieved after 60 femoral and 95 radial cases based on fluoroscopy time, 52 femoral and 77 radial cases based on procedure time, and 53 femoral and 64 radial cases based on contrast volume.
Our study demonstrates that the use of TRA can be safely incorporated into neuroendovascular training without causing an increase in complications or significantly prolonging procedure time or contrast use.
与传统的经股动脉入路（TFA）相比，桡动脉入路（TRA）在神经血管介入中具有明显的优势，因此迅速普及。然而，向 TRA 的过渡带来了一些挑战，包括优化介入套件设置和工作流程，以及对住院医师培训的影响。
比较 TFA 和 TRA 用于神经介入住院医师培训中的诊断性脑血管造影的学习曲线。
我们前瞻性地收集了 2018 年 7 月至 2019 年 6 月在我们机构接受培训的 2 名无血管内经验的神经介入住院医师的诊断性血管造影程序数据。操作人员熟练程度的衡量标准是透视时间、手术时间和使用的造影剂体积。
共纳入 293 例诊断性血管造影。其中，57.7%为 TRA，42.3%为 TFA。中位数造影剂剂量为 60cc，中位数辐射剂量为 14000μGy。总的并发症发生率为 1.4%，包括 2 例股部血肿、1 例腕部血肿和 1 例 TFA 引起的入路部位感染。改用 TFA 的交叉率为 2.1%。根据透视时间，TRA 达到熟练程度的病例数为 60 例，TFA 为 52 例；根据手术时间，TRA 达到熟练程度的病例数为 95 例，TFA 为 77 例；根据造影剂用量，TRA 达到熟练程度的病例数为 53 例，TFA 为 64 例。
我们的研究表明，在神经血管介入培训中可以安全地使用 TRA，而不会增加并发症，也不会显著延长手术时间或造影剂使用量。
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