Krothapalli Neeharika, Fayad Mohamad, Patel Smit, Elmashad Ahmed, Sussman Eric, Bruno Charles, Grande Andrew, Jagadeesan Bharathi, Killory Brendan, Alberts Mark, Kureshi Inam, Ollenschleger Martin, Tummala Ramachandra, Mehta Tapan
Department of Neurology, University of Connecticut, Farmington, CT, United States.
Department of Interventional Neuroradiology, Hartford Hospital, Hartford, CT, United States.
Front Neurol. 2022 Oct 25;13:990722. doi: 10.3389/fneur.2022.990722. eCollection 2022.
Trans-radial access (TRA) for MMA embolization has grown due to lower access site complications and greater patient satisfaction. Here, we describe the feasibility of utilizing a 6F Envoy Simmons 2 (6F-SIM2) as a guide catheter with TRA and compare outcomes with trans-femoral approach (TFA) in a single center case series.
We performed a retrospective review of patients who underwent MMA embolization for management of chronic subdural hematoma (cSDH). TRA was performed by utilizing a combination of 6F 90cm Envoy (Codman & Shurtleff, Inc., Rayham, MA) Simmons 2 guide catheter and 5F 125cm Sofia (Microvention, Aliso Viejo, CA) intermediate catheter. Outcomes measured are Modified Rankin Score (mRS) at 90 days, inpatient mortality, post-embolization recurrence, fluoroscopy time and radiation exposure.
A total of 71 patients underwent 97 MMA embolization overall with 65 (67%) in trans-femoral access group, 11 (11.3%) in trans-radial access without use of Simmons 2 Guide catheter group and 21 (21.6%) in trans-radial access with use of Simmons 2 Guide catheter group. There were no direct access-related complications in either group. One patient had thromboembolic stroke in trans-femoral group. There was no difference in average procedure-related total fluro time or radiation dose among all three groups.
Trans-radial approach using 6F-SIM2 guide catheter coupled with 5F Sofia intermediate catheter is safe and effective. It provides an alternative approach to access distal branches of bilateral anterior circulation in elderly patients with difficult anatomy undergoing MMA embolization.
由于较低的穿刺部位并发症和更高的患者满意度，经桡动脉途径（TRA）用于脑膜中动脉（MMA）栓塞术的应用有所增加。在此，我们描述了使用6F Envoy Simmons 2（6F-SIM2）作为经桡动脉途径的引导导管的可行性，并在一个单中心病例系列中比较经桡动脉途径与经股动脉途径（TFA）的结果。
我们对因慢性硬膜下血肿（cSDH）接受MMA栓塞术的患者进行了回顾性研究。经桡动脉途径采用6F 90cm Envoy（Codman & Shurtleff公司，马萨诸塞州雷纳姆）Simmons 2引导导管和5F 125cm Sofia（Microvention公司，加利福尼亚州阿利索维耶霍）中间导管联合使用。测量的结果包括90天时的改良Rankin量表（mRS）评分、住院死亡率、栓塞后复发率、透视时间和辐射暴露量。
总共71例患者接受了97次MMA栓塞术，其中经股动脉途径组65例（67%），未使用Simmons 2引导导管的经桡动脉途径组11例（11.3%），使用Simmons 2引导导管的经桡动脉途径组21例（21.6%）。两组均未发生直接与穿刺相关的并发症。经股动脉组有1例患者发生血栓栓塞性中风。三组之间平均与手术相关的总透视时间或辐射剂量没有差异。
使用6F-SIM2引导导管联合5F Sofia中间导管的经桡动脉途径是安全有效的。它为解剖结构复杂的老年患者在接受MMA栓塞术时提供了一种进入双侧前循环远端分支的替代途径。
