Department of Neurosurgery, Geisinger, Wilkes-Barre, Pennsylvania, USA.
Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.
Oper Neurosurg (Hagerstown). 2023 May 1;24(5):476-482. doi: 10.1227/ons.0000000000000567. Epub 2022 Dec 16.
Intraoperative cerebral angiography (IOA) is a valuable adjunct in open and hybrid cerebrovascular surgery. Commonly, transfemoral access (TFA) is used. Lately, transradial access (TRA) has gained popularity for neurointervention. However, the TRA has not yet been compared with the TFA for IOA.
To compare the effectiveness and safety of the TRA and TFA for IOA. In addition, the learning curve for implementing the TRA for IOA was evaluated.
Between July 2020 and 2022, 92/1787 diagnostic cerebral angiographies met inclusion criteria for IOA. Sheath run time to primary target vessel run time (STT), amount of contrast dye (CD), fluoroscopy time (FT), and dose-area products (DAPs) were compared between TRA and TFA, different aortic arch types, and both study years.
One case required transitioning from TRA to TFA (1/26, 3.8%) because of a minute proximal radial vasculature. The STT, CD, FT, and DAP were similar for the TRA (n = 25) and the TFA groups (n = 67) (p = ns). One groin hematoma (1.5%) was observed in the TFA group. No other complications or any change in modified Rankin Scale were observed. Aortic arch type II/III was associated with longer STT ( P = .032) but not CD, FT, or DAP. There was a nonsignificant decline of STTs among the TRA cases ( P = .104) but stable STTs among TFA cases ( P = .775).
The TRA and TFA represent equally effective and safe routes for IOA. In addition, expertise with the TRA can rapidly be gained and facilitates tailoring the access for IOA to patient's individual anatomy and surgeon's needs.
术中脑血管造影（IOA）是开放和杂交脑血管手术的重要辅助手段。通常使用经股动脉入路（TFA）。最近，经桡动脉入路（TRA）在神经介入中越来越受欢迎。然而，TRA 尚未与 TFA 进行 IOA 比较。
比较 TRA 和 TFA 用于 IOA 的效果和安全性。此外，还评估了实施 TRA 进行 IOA 的学习曲线。
2020 年 7 月至 2022 年，92/1787 例诊断性脑血管造影符合 IOA 纳入标准。比较 TRA 和 TFA 组、不同主动脉弓类型和两个研究年份的鞘管运行时间至主要靶血管运行时间（STT）、造影剂用量（CD）、透视时间（FT）和剂量面积乘积（DAP）。
1 例因近端桡动脉血管微小而需要从 TRA 转为 TFA（1/26，3.8%）。TRA（n=25）和 TFA 组（n=67）的 STT、CD、FT 和 DAP 相似（p=ns）。TFA 组观察到 1 例腹股沟血肿（1.5%）。未观察到其他并发症或改良 Rankin 量表的任何变化。主动脉弓 II/III 型与较长的 STT 相关（P=0.032），但与 CD、FT 或 DAP 无关。TRA 病例的 STT 呈非显著性下降（P=0.104），而 TFA 病例的 STT 则稳定（P=0.775）。
TRA 和 TFA 是 IOA 同样有效的和安全的途径。此外，TRA 的专业知识可以迅速获得，并有利于根据患者的个体解剖结构和外科医生的需求来定制 IOA 的入路。
