J Neurosurg. 2022 Nov 4;139(1):157-164. doi: 10.3171/2022.9.JNS221642. Print 2023 Jul 1.
Transradial access (TRA) has received considerable attention in the field of neurointervention owing to its advantages over transfemoral access. However, the difficulty of left internal carotid artery (ICA) navigation under certain anatomical conditions of the aortic arch and its branches is a limitation of right TRA. In this study the authors aimed to investigate the anatomical predictors that impede navigation of the left ICA in right TRA.
From January to October 2020, 640 patients underwent transradial angiography at a single institute. Among them, 263 consecutive patients who were evaluated by contrast-enhanced MRA before transradial angiography were included in the study and assigned to success or failure groups according to whether left ICA navigation was possible or not. Several anatomical predictors were investigated to evaluate the correlation of the success of left ICA navigation in right TRA.
A higher grade of the aortic arch type (type I vs type III: OR 6.323, p = 0.0171), higher height of the right subclavian artery (OR 1.071, p = 0.0068), narrower turnoff angle of the left common carotid artery (CCA) (OR 0.953, p = 0.0017), wider distance between the innominate artery and the left CCA (OR 1.784, p < 0.0001), steeper angulation of the right subclavian artery (tortuous vs kinking: OR 6.323, p = 0.0066), and steeper angulation of the left CCA (normal vs tortuous: OR 7.453, p = 0.0087; normal vs kinking: OR 51.65, p < 0.0001) were significantly associated with successful navigation of the left ICA. The cutoff value of the height of the right subclavian artery, distance between the innominate artery and the left CCA, turnoff angle of the left CCA, and diameter of the left CCA were 54.83 mm, 4.25 mm, 17°, and 6.05 mm, respectively.
Successful left ICA navigation in right TRA was related to the specific vascular geometry of the aortic arch and its branches. Preprocedural evaluation of the anatomical predictors identified in this study may enhance the success rate of left ICA navigation in right TRA.
经桡动脉入路（TRA）在神经介入领域受到广泛关注，因为它优于经股动脉入路。然而，在主动脉弓及其分支的某些解剖条件下，左颈内动脉（ICA）的导航难度是右 TRA 的一个限制。本研究旨在探讨TRA 中影响左 ICA 导航的解剖学预测因素。
2020 年 1 月至 10 月，一家机构对 640 例行经桡动脉造影的患者进行了研究。其中，263 例连续患者在经桡动脉造影前接受了对比增强 MRA 评估，根据是否能够进行左 ICA 导航，将其分为成功组和失败组。研究了几个解剖学预测因素，以评估TRA 中左 ICA 导航成功的相关性。
主动脉弓类型较高（I 型 vs III 型：比值比 6.323，p = 0.0171）、右锁骨下动脉高度较高（比值比 1.071，p = 0.0068）、左颈总动脉（CCA）的转弯角度较窄（比值比 0.953，p = 0.0017）、无名动脉与左 CCA 之间的距离较宽（比值比 1.784，p < 0.0001）、右锁骨下动脉角度较陡（迂曲 vs 扭曲：比值比 6.323，p = 0.0066）、左 CCA 角度较陡（正常 vs 迂曲：比值比 7.453，p = 0.0087；正常 vs 扭曲：比值比 51.65，p < 0.0001）与左 ICA 成功导航明显相关。右锁骨下动脉高度、无名动脉与左 CCA 之间的距离、左 CCA 的转弯角度和左 CCA 的直径的截断值分别为 54.83mm、4.25mm、17°和 6.05mm。
TRA 中左 ICA 导航的成功与主动脉弓及其分支的特定血管几何形状有关。本研究中确定的解剖学预测因素的术前评估可以提高右 TRA 中左 ICA 导航的成功率。
