急性缺血性卒中患者接受血管内血栓切除术时经桡动脉入路和经股动脉入路与手术结局的关联：一项荟萃分析。
The association of transradial access and transfemoral access with procedural outcomes in acute ischemic stroke patients receiving endovascular thrombectomy: A meta-analysis.
作者信息
Shaban Shirin, Rastogi Aarushi, Phuyal Subash, Huasen Bella, Haridas Abilash, Zelenak Kamil, Iacobucci Marta, Martínez-Galdámez Mario, Jabbour Pascal, Bhaskar Sonu Menachem Maimonides
机构信息
Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; University of New South Wales (UNSW), South-Western Sydney Clinical School, NSW, Australia.
Division of Neurointerventional Surgery, Neuroimaging, and Interventional Radiology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Kathmandu, Nepal.
出版信息
Clin Neurol Neurosurg. 2022 Apr;215:107209. doi: 10.1016/j.clineuro.2022.107209. Epub 2022 Mar 11.
OBJECTIVE
There is an ongoing debate regarding the benefits of using transradial access (TRA) over transfemoral access (TFA) in endovascular therapies including endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) patients. This study sought to investigate the association of TRA and TFA with procedural success, access-site complications, first-pass reperfusion (FPR), puncture-to-recanalisation (PTR) time and hemorrhagic transformation (HT) by performing a meta-analysis.
MATERIALS AND METHODS
PubMed, EMBASE and Scopus were searched. Studies with patients aged ≥ 18 years and head-to-head TRA vs TFA comparisons were included. Random-effects modeling was performed to obtain summary effects and forest plots were plotted to study the association of TFA with access site complications, FPR, HT, PTR time and procedural success.
RESULTS
Six studies encompassing 945 patients (347 TRA and 598 TFA) were included in the meta-analysis. Meta-analysis revealed that in AIS patients receiving EVT, TRA was significantly associated with a decreased risk of access-site complications (RR 0.17, 95% CI 0.05 0.54; p = 0.003, z = -2.957) and HT (RR 0.07, 95% CI 0.02 0.27; p < 0.0001, z = -3.8841). However, TRA was not significantly associated with procedural success (RR 0.96, 95% CI 0.90 1.01; p = 0.141, z = -1.473), FPR (RR 0.91, 95% CI 0.79 1.05; p = 0.194, z = -1.299) and PTR time (SMD -0.14, 95% CI -0.42 -0.14; p = 0.323, z = -0.989).
CONCLUSION
Our meta-analysis demonstrated that TRA is a safe alternative to TFA, in AIS patients receiving EVT, with significantly decreased access-site complications and HT with TRA, albeit with comparable procedural success, FPR and PTR time to TFA.
DATA AVAILABILITY STATEMENT
The original contributions presented in the study are included in the article/Supplementary information, further inquiries can be directed to the corresponding author.
目的
在包括急性缺血性卒中（AIS）患者的血管内血栓切除术（EVT）在内的血管内治疗中，关于经桡动脉入路（TRA）相较于经股动脉入路（TFA）的益处存在持续争论。本研究旨在通过进行荟萃分析，探讨TRA和TFA与手术成功率、穿刺部位并发症、首次通过再灌注（FPR）、穿刺至再通（PTR）时间及出血转化（HT）之间的关联。
材料与方法
检索了PubMed、EMBASE和Scopus数据库。纳入年龄≥18岁患者且TRA与TFA进行直接比较的研究。采用随机效应模型获得汇总效应，并绘制森林图以研究TFA与穿刺部位并发症、FPR、HT、PTR时间及手术成功率之间的关联。
结果
荟萃分析纳入了6项研究，共945例患者（347例TRA和598例TFA）。荟萃分析显示，在接受EVT的AIS患者中，TRA与穿刺部位并发症风险降低显著相关（RR 0.17，95%CI 0.05至0.54；p = 0.003，z = -2.957）以及与HT显著相关（RR 0.07，95%CI 0.02至0.27；p < 0.0001，z = -3.8841）。然而，TRA与手术成功率（RR 0.96，95%CI 0.90至1.01；p = 0.141，z = -1.473）、FPR（RR 0.91，95%CI 0.79至1.05；p = 0.194，z = -1.299）及PTR时间（SMD -0.14，95%CI -0.42至0.14；p = 0.323，z = -0.989）无显著关联。
结论
我们的荟萃分析表明，在接受EVT的AIS患者中，TRA是TFA的一种安全替代方法，TRA可显著降低穿刺部位并发症和HT，尽管其手术成功率、FPR及PTR时间与TFA相当。
数据可用性声明
研究中呈现的原始贡献包含在文章/补充信息中，进一步的询问可联系通讯作者。
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