经桡动脉与经股动脉入路行颅内动脉瘤血管内治疗的比较：队列研究的系统评价和荟萃分析。
Transradial versus transfemoral access for endovascular therapy of intracranial aneurysms: a systematic review and meta-analysis of cohort studies.
机构信息
Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China.
Department of Neurology, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, China.
出版信息
Neurosurg Rev. 2022 Dec;45(6):3489-3498. doi: 10.1007/s10143-022-01868-3. Epub 2022 Sep 21.
Endovascular treatment is widely used in the treatment of intracranial aneurysms. However, neurosurgeons are sceptical about endovascular access via the radial artery. We performed a systematic review and meta-analysis to compare the effectiveness and safety of transradial and transfemoral artery access in patients with intracranial aneurysms. We systematically searched the PubMed, Embase, and Cochrane databases for studies comparing the two approaches. The primary outcome was total complications, and the secondary outcomes were access site complications, intracranial haemorrhage, stroke, thromboembolism, silent infarct, re-treatment rate, mortality, complete occlusion of intracranial aneurysms, procedure duration, and length of hospital stay. A random-effects model was used to assess the pooled data. Of the 100 identified studies, 6 were eligible (a total of 3764 participants). There were no significant differences in total complications(odds ratio [OR] = 0.69, 95% confidence interval [CI] [0.33, 1.45], p = 0.32), complete occlusion of intracranial aneurysms (OR = 1.02, 95%CI [0.77,1.37], p = 0.87), procedure duration (mean difference [MD] = - 6.24, 95%CI [- 14.75, - 1.54], p = 0.95), or length of hospital stay (MD = 2.204, 95%CI [- 0.05, 4.45], p = 0.95), access site complications (OR = 0.49, 95%CI [0.16, 1.52], p = 0.22), intracranial haemorrhage (OR = 1.07, 95%CI [0.49, 2.34], p = 0.86), stroke (OR = 0.59, 95%CI [0.20, 1.77], p = 0.35), thromboembolism (OR = 0.85, 95%CI [0.33, 2.17], p = 0.74), silent infarct (OR = 0.69, 95%CI [0.04, 11.80], p = 0.80), retreatment rate (OR = 1.32, 95%CI [0.70, 2.48], p = 0.39), mortality (OR = 1.41, 95%CI [0.06, 5.20], p = 0.61), immediate occlusion (OR = 0.99, 95%CI [0.64, 1.51], p = 0.95), and occlusion during follow-up (OR = 1.10, 95%CI [0.56, 2.16], p = 0.74) between the transradial and transfemoral groups. This study showed comparable safety and efficacy outcomes between transradial and transfemoral access in patients with intracranial aneurysms treated endovascularly. Future large randomised trials are warranted to confirm these findings.
血管内治疗广泛应用于颅内动脉瘤的治疗。然而，神经外科医生对经桡动脉的血管内入路持怀疑态度。我们进行了一项系统评价和荟萃分析，比较了经桡动脉和股动脉入路在颅内动脉瘤患者中的有效性和安全性。我们系统地检索了 PubMed、Embase 和 Cochrane 数据库，以比较两种方法。主要结局是总并发症，次要结局是入路部位并发症、颅内出血、卒中和血栓栓塞、无症状梗死、再治疗率、死亡率、颅内动脉瘤完全闭塞、手术时间和住院时间。采用随机效应模型评估汇总数据。在 100 项确定的研究中，有 6 项符合条件（共 3764 名参与者）。总并发症无显著差异（比值比 [OR] = 0.69，95%置信区间 [CI] [0.33, 1.45]，p = 0.32），颅内动脉瘤完全闭塞（OR = 1.02，95%CI [0.77,1.37]，p = 0.87），手术时间（均值差 [MD] = -6.24，95%CI [-14.75, -1.54]，p = 0.95），或住院时间（MD = 2.204，95%CI [-0.05, 4.45]，p = 0.95），入路部位并发症（OR = 0.49，95%CI [0.16, 1.52]，p = 0.22），颅内出血（OR = 1.07，95%CI [0.49, 2.34]，p = 0.86），卒中和血栓栓塞（OR = 0.59，95%CI [0.20, 1.77]，p = 0.35），无症状梗死（OR = 0.69，95%CI [0.04, 11.80]，p = 0.80），再治疗率（OR = 1.32，95%CI [0.70, 2.48]，p = 0.39），死亡率（OR = 1.41，95%CI [0.06, 5.20]，p = 0.61），即刻闭塞（OR = 0.99，95%CI [0.64, 1.51]，p = 0.95）和随访期间闭塞（OR = 1.10，95%CI [0.56, 2.16]，p = 0.74）在经桡动脉和股动脉组之间无显著差异。本研究显示，血管内治疗颅内动脉瘤患者经桡动脉和股动脉入路具有相似的安全性和疗效。需要进一步的大型随机试验来证实这些发现。
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