Maciejewski Damian R, Tekieli Łukasz, Trystuła Mariusz, Tomaszewski Tomasz, Machnik Roman, Legutko Jacek, Kazibudzki Marek, Musiał Robert, Misztal Marcin, Pieniążek Piotr
Department of Interventional Cardiology, Institute of Cardiology, Medical College, Jagiellonian University, John Paul II Hospital, Krakow, Poland.
Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2020 Dec;16(4):410-417. doi: 10.5114/aic.2020.101765. Epub 2020 Dec 29.
Radial or brachial access may be preferred in the case of severe peripheral artery disease (PAD) or difficult aortic arch anatomy during carotid artery stenting (CAS).
To evaluate the clinical conditions indicating potential benefit from non-femoral access as well as feasibility and safety of transradial/transbrachial access (TRA/TBA) as an alternative approach for CAS.
Since 2013, 67 patients (mean age: 70 years old, 44 men, 42% symptomatic) were selected for CAS with the TRA/TBA approach. The composite endpoint was stroke/death/myocardial infarction within 30 days of the procedure and compared to the propensity score matched transfemoral approach (TFA) group. Clinical (including neurological) examination and Doppler ultrasonography were performed before the procedure, at discharge and at 30 days.
CAS with TRA/TBA was successful in 63/67 patients. Transfemoral access was not feasible due to PAD in 35 (52.2%) patients, bovine arch in 10 (14.9%), obesity (BMI > 35 kg/m) in 9 (13.4%), severe degenerative disease of the spine in 7 (10.5%), arch type III in 5 (7.5%) and excessive subclavian stent protrusion in 1 (1.5%) patient. Mean NASCET carotid artery stenosis was reduced from 81% to 9% ( < 0.001). The composite endpoint occurred in 3 (4.8%) cases and it was not statistically significantly different from the matched TFA group (6.3%; = 0.697). No access site complications requiring surgical intervention or blood transfusion developed.
Transradial and transbrachial CAS may be an effective and safe procedure, and it may constitute a viable alternative to the femoral approach in patients with severe PAD, difficult aortic arch anatomy or obesity.
在严重外周动脉疾病（PAD）或颈动脉支架置入术（CAS）期间主动脉弓解剖结构复杂的情况下，桡动脉或肱动脉入路可能更受青睐。
评估表明非股动脉入路可能有益的临床情况，以及经桡动脉/经肱动脉入路（TRA/TBA）作为CAS替代方法的可行性和安全性。
自2013年以来，67例患者（平均年龄：70岁，44例男性，42%有症状）被选择采用TRA/TBA方法进行CAS。复合终点是术后30天内发生的卒中/死亡/心肌梗死，并与倾向评分匹配的经股动脉入路（TFA）组进行比较。在术前、出院时和30天时进行临床（包括神经学）检查和多普勒超声检查。
67例患者中有63例TRA/TBA CAS成功。由于PAD，35例（52.2%）患者经股动脉入路不可行；因牛型主动脉弓，10例（14.9%）患者不可行；因肥胖（BMI>35kg/m），9例（13.4%）患者不可行；因严重脊柱退行性疾病，7例（10.5%）患者不可行；因III型主动脉弓，5例（7.5%）患者不可行；因锁骨下支架突出过多，1例（1.5%）患者不可行。平均北美症状性颈动脉内膜切除术（NASCET）颈动脉狭窄率从81%降至9%（P<0.001）。复合终点在3例（4.8%）患者中出现，与匹配的TFA组（6.3%）相比无统计学显著差异（P=0.697）。未发生需要手术干预或输血的穿刺部位并发症。
经桡动脉和经肱动脉CAS可能是一种有效且安全的手术，对于严重PAD、主动脉弓解剖结构复杂或肥胖患者，它可能是股动脉入路的可行替代方法。
