Neurosurgical Associates of San Antonio, University of Texas Health Science Center, San Antonio, Texas, USA.
Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas, USA.
World Neurosurg. 2021 Jul;151:6-11. doi: 10.1016/j.wneu.2021.04.012. Epub 2021 Apr 20.
Transradial access is an increasingly popular route for cerebral angiography and neurointerventions. However, obstacles to wider adoption remain, especially for complex interventions typically performed with larger, multiaxial systems such as flow diversion. We sought to analyze the published evidence for transradial flow diversion of intracranial aneurysms.
Using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a literature review was performed to identify all published reports and studies of transradial flow diversion for intracranial aneurysm. The search was limited from April 2011 to February 2021. Primary outcome was successful completion of the procedure via a transradial approach. Heterogeneity was analyzed with Q and I statistics. Secondary outcomes were transradial access-site complications and other complications.
In total, 11 studies involving 290 treated aneurysms were identified; 90.7% of the procedures were completed via the transradial approach. The heterogeneity between studies was high, with an I of 56.9%. There were no transradial access-site complications. The procedural complication rate was 2.41%.
Transradial access has a high success rate for both anterior and posterior circulation flow-diversion embolizations. The success rate may be particularly high for posterior circulation and right anterior circulation aneurysms. It has a negligible access-site complication rate. Transradial access is a viable alternative to transfemoral access for flow diversion and should be considered as a first-line approach.
经桡动脉入路越来越多地用于脑动脉造影和神经介入。然而，广泛采用仍存在障碍，尤其是对于通常使用较大的多轴系统（如血流转向装置）进行的复杂介入。我们旨在分析颅内动脉瘤经桡动脉血流转向的已发表证据。
使用系统评价和荟萃分析的首选报告项目（PRISMA）指南，对所有已发表的关于颅内动脉瘤经桡动脉血流转向的报告和研究进行了文献回顾。搜索范围限于 2011 年 4 月至 2021 年 2 月。主要结果是通过经桡动脉途径成功完成该手术。采用 Q 和 I 统计分析异质性。次要结果是经桡动脉入路部位并发症和其他并发症。
共确定了 11 项涉及 290 个治疗动脉瘤的研究；90.7%的手术是通过经桡动脉途径完成的。研究之间的异质性很高，I 为 56.9%。没有经桡动脉入路部位并发症。手术并发症发生率为 2.41%。
经桡动脉入路在前循环和后循环血流转向栓塞中均具有很高的成功率。对于后循环和右前循环动脉瘤，成功率可能特别高。它具有可忽略的入路部位并发症发生率。经桡动脉入路是血流转向的一种可行的股动脉入路替代方法，应考虑作为一线方法。
