Chen Stephanie H, Suazo Roberto, Saini Vasu, Abecassis Isaac Josh, Yavagal Dileep, Starke Robert M, Peterson Eric C
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Oper Neurosurg (Hagerstown). 2021 May 13;20(6):E431-E432. doi: 10.1093/ons/opab071.
A number of studies have demonstrated that the radial artery is a safer access site than the femoral artery for endovascular procedures.1-4 In the prospective randomized studies comparing transradial and transfemoral approaches for cardiac procedures, there was a 60% reduction in access site complications as well as significant decreases in all-cause mortality with the transradial approach as compared to transfemoral, which has led to the adoption of a radial first strategy.5-7 Neurointerventional studies have demonstrated similar safety benefits as well as improved patient preference.8-14 In this video, a patient presented with an unruptured anterior communicating artery aneurysm and consented to a transradial artery diagnostic cerebral angiogram. This technical video demonstrates the key preprocedural preparation, room setup, patient positioning, steps for radial artery, and distal radial artery puncture and sheath placement. Distal transradial artery access is our preferred approach for diagnostic cerebral angiography because of an improved safety profile and procedural ergonomics. In cases in which a larger radial artery is advantageous such as for neurointerventions requiring larger systems, a standard transradial approach may be performed.9 In this video, a full 6-vessel cerebral angiogram is performed, followed by our arteriotomy closure technique using our standard equipment including a 10-cm 5 French Glidesheath Slender (Terumo, Japan), 100-cm hydrophilic coated 5 French Simmons 1 catheter (Merit OEM), 0.035 hydrophilic coated guidewire, and SafeGuard closure device (Merit, Salt Lake City, Utah).
多项研究表明，在血管内介入手术中，桡动脉是比股动脉更安全的入路部位。1-4 在比较经桡动脉和经股动脉心脏手术入路的前瞻性随机研究中，与经股动脉入路相比，经桡动脉入路的入路部位并发症减少了60%，全因死亡率也显著降低，这导致了桡动脉优先策略的采用。5-7 神经介入研究也证明了类似的安全性益处以及患者更高的偏好度。8-14 在本视频中，一名患者患有未破裂的前交通动脉瘤，并同意进行经桡动脉诊断性脑血管造影。本技术视频展示了关键的术前准备、手术室设置、患者体位、桡动脉穿刺步骤以及桡动脉远端穿刺和鞘管置入。由于安全性更高和操作更符合人体工程学，桡动脉远端入路是我们诊断性脑血管造影的首选方法。在一些需要较大桡动脉的情况下，例如对于需要更大系统的神经介入手术，可采用标准的经桡动脉入路。9 在本视频中，进行了完整的六血管脑血管造影，随后展示了我们使用标准设备的动脉切开闭合技术，这些设备包括一根10厘米长的5法国规格的纤细型Glidesheath鞘管（日本泰尔茂公司）、一根100厘米长的亲水涂层5法国规格的西蒙斯1型导管（美力特OEM）、一根0.035亲水涂层导丝以及SafeGuard闭合装置（美力特公司，美国犹他州盐湖城）。
