Choi Dae Han, Yoo Chan Jong, Park Cheol Wan, Kim Myeong Jin
Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Interv Neuroradiol. 2023 Jun;29(3):229-234. doi: 10.1177/15910199221083102. Epub 2022 Mar 2.
Catheter angiography via transradial access (TRA) is better at reducing access site complications and morbidity than via transfemoral access (TFA). The rate of periprocedural complications increases in elderly populations and using a smaller sheath can help reduce access site complications. The aim of this study was to assess the feasibility and safety of 4 F sheath-based TRA cerebral angiography in elderly patients (≥65 years) and compare it to TFA cerebral angiography.
The medical records of elderly patients undergoing diagnostic cerebral angiography with a single neurointerventionalist via TRA (57 cases, from July 2019 to December 2020) versus TFA (69 cases, from January 2018 to June 2019) were retrospectively reviewed. All TRA angiographies were performed via right radial artery access with a 4 F sheath and a 4 F Simmons 2 catheter.
There were no significant differences (TRA vs. TFA) in age (71.1 ± 4.0 vs. 72.1 ± 4.6 years, p = 0.189), accessed vessels (3.9 ± 0.5 vs. 3.9 ± 0.6, p = 0.852), fluoroscopy time (7.1 ± 3.3 vs. 7.6 ± 3.5 min, p = 0.068), and radiation exposure (42.1 ± 15.8 vs. 47.0 ± 13.7 Gy-cm, p = 0.067). However, the procedure duration was significantly shorter in the TRA group (17.2 ± 3.9 vs. 19.0 ± 6.0 min, p = 0.003). Painful groin hematoma occurred in 2 of the 69 cases (2.9%) in the TFA group. In the TRA group, access site complications were not occurred; however, catheter kinks occurred in 2 of 57 cases (3.5%).
The 4 F sheath-based TRA is a feasible option for diagnostic cerebral angiography in elderly patients. However, care should be taken during catheter manipulation.
经桡动脉入路（TRA）行导管血管造影术在减少穿刺部位并发症和发病率方面优于经股动脉入路（TFA）。老年人群围手术期并发症发生率增加，使用较小的鞘管有助于减少穿刺部位并发症。本研究的目的是评估基于4F鞘管的TRA脑血管造影术在老年患者（≥65岁）中的可行性和安全性，并将其与TFA脑血管造影术进行比较。
回顾性分析2019年7月至2020年12月期间由单一神经介入医生经TRA行诊断性脑血管造影术的老年患者（57例）与2018年1月至2019年6月期间经TFA行诊断性脑血管造影术的老年患者（69例）的病历。所有TRA血管造影术均通过右桡动脉入路，使用4F鞘管和4F Simmons 2导管进行。
年龄（71.1±4.0岁 vs. 72.1±4.6岁，p = 0.189）、穿刺血管数量（3.9±0.5 vs. 3.9±0.6，p = 0.852）、透视时间（7.1±3.3 vs. 7.6±3.5分钟，p = 0.068）和辐射暴露量（42.1±15.8 vs. 47.0±13.7 Gy-cm，p = 0.067）在TRA组和TFA组之间无显著差异。然而，TRA组的手术时间明显更短（17.2±3.9 vs. 19.0±6.0分钟，p = 0.003）。TFA组69例中有2例（2.9%）发生腹股沟疼痛性血肿。在TRA组中，未发生穿刺部位并发症；然而，57例中有2例（3.5%）发生导管扭曲。
基于4F鞘管的TRA是老年患者诊断性脑血管造影术的一种可行选择。然而，在导管操作过程中应谨慎。
