Ahmed Maham, Zyck Stephanie, Gould Grahame C
Department of Neurological Surgery, SUNY Upstate Medical University, Syracuse, New York, United States.
Department of Neurological Surgery, Ohio State University Hospital, Columbus, Ohio, United States.
Surg Neurol Int. 2021 Oct 11;12:513. doi: 10.25259/SNI_711_2021. eCollection 2021.
Transradial access (TRA) for diagnostic and interventional neuroendovascular procedures has gained significant popularity in recent years due to its improved safety profile and appeal to patients compared with transfemoral access. However, risks of TRA include hand ischemia in cases of poor ulnar collateral circulation and inability to cannulate the radial artery due to its relatively small diameter. By accessing the radial artery distal to the superficial palmar arch where ulnar collateral blood flow arises, in the anatomic snuffbox, the risk of hand ischemia is theoretically eliminated. The use of subcutaneous nitroglycerin and lidocaine to improve rates of success in radial artery access has been reported in the cardiac literature, however, has yet to be described for neurointerventional procedures. We discuss our technique and report our initial experience using subcutaneous nitroglycerin and lidocaine cocktail for access to the distal transradial artery in a variety of neuroendovascular procedures.
A retrospective review of our institution's database of neurointerventional and diagnostic procedures performed using dTRA was conducted, and 64 patients were identified between February and December 2020. Patient demographics, clinical data, procedural details, and radiographic information were collected and analyzed.
A total of 64 patients underwent neurointerventional procedures using the subcutaneous injection for dTRA access. The procedures performed included diagnostic cerebral angiograms ( = 47), stent and balloon assisted aneurysm coiling ( = 5), flow diversion ( = 2), intra-saccular device placement ( = 1), mechanical thrombectomy ( = 1), tumor embolization ( = 1), middle meningeal artery embolization ( = 2), extracranial carotid stent placement ( = 2), and arteriovenous malformation embolization ( = 3). While no complications of hand ischemia were appreciated, the access site conversion rate was 3.1%; 2 cases required a switch to femoral artery access due to proximal vessel tortuosity and aortic anatomical variations, and not due to access site complication. Furthermore, on repeat angiograms by the same proceduralist, distal TRA (dTRA) was successful in 100% of the cases.
dTRA using subcutaneous nitroglycerin and lidocaine is a safe and effective method for neurointerventional and diagnostic procedures.
近年来，与经股动脉入路相比，经桡动脉入路（TRA）用于诊断性和介入性神经血管内手术因其安全性提高且更受患者欢迎而得到广泛应用。然而，TRA的风险包括尺侧侧支循环不良时的手部缺血以及由于桡动脉直径相对较小而无法成功穿刺。通过在掌浅弓远端、尺侧侧支血流起始处的桡动脉进行穿刺，即在解剖鼻烟窝处穿刺，理论上可消除手部缺血的风险。在心脏领域的文献中已报道使用皮下硝酸甘油和利多卡因来提高桡动脉穿刺成功率，但在神经介入手术中尚未见相关描述。我们讨论了我们的技术，并报告了我们在各种神经血管内手术中使用皮下硝酸甘油和利多卡因混合剂进行远端经桡动脉穿刺的初步经验。
对我们机构使用远端经桡动脉穿刺（dTRA）进行的神经介入和诊断手术数据库进行回顾性分析，确定了2020年2月至12月期间的64例患者。收集并分析了患者的人口统计学资料、临床数据、手术细节和影像学信息。
共有64例患者使用皮下注射进行dTRA穿刺以接受神经介入手术。所进行的手术包括诊断性脑血管造影（n = 47）、支架和球囊辅助动脉瘤栓塞（n = 5）、血流导向（n = 2）、囊内装置置入（n = 1）、机械取栓（n = 1）、肿瘤栓塞（n = 1）、脑膜中动脉栓塞（n = 2）、颅外颈动脉支架置入（n = 2）以及动静脉畸形栓塞（n = 3）。虽然未发现手部缺血并发症，但穿刺部位转换率为3.1%；2例因近端血管迂曲和主动脉解剖变异而需要转为股动脉入路，而非穿刺部位并发症所致。此外，在同一位手术医生进行的重复血管造影中，远端经桡动脉穿刺（dTRA）成功率为100%。
使用皮下硝酸甘油和利多卡因的dTRA是一种安全有效的神经介入和诊断手术方法。
