Fuga Michiyasu, Tanaka Toshihide, Tachi Rintaro, Tomoto Kyoichi, Wachi Ryoto, Teshigawara Akihiko, Ishibashi Toshihiro, Hasegawa Yuzuru, Murayama Yuichi
Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan.
Department of Neurosurgery, Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
Surg Neurol Int. 2023 Jul 7;14:233. doi: 10.25259/SNI_355_2023. eCollection 2023.
The transradial approach (TRA) is less invasive than the transfemoral approach (TFA), but the higher conversion rate represents a drawback. Among target vessels, the left internal carotid artery (ICA) is particularly difficult to deliver the guiding catheter to through TRA. The purpose of this study was thus to explore anatomical and clinical features objectively predictive of the difficulty of delivering a guiding catheter into the left ICA via TRA.
Among 78 consecutive patients who underwent coil embolization for unruptured intracranial aneurysms through TRA in a single institution between March 1, 2021, and August 31, 2022, all 29 patients (37%) who underwent delivery of the guiding catheter into the left ICA were retrospectively analyzed. Clinical and anatomical features were analyzed to assess correlations with difficulty in guiding the catheter into the left ICA.
Of the 29 aneurysms requiring guidance of a catheter into the left ICA, 9 aneurysms (31%) required conversion from TRA to TFA. More acute innominate-left common carotid artery (CCA) angle ( < 0.001) and older age ( = 0.015) were associated with a higher conversion rate to TFA. Receiver operating characteristic analysis revealed that optimal cutoff values for the innominate-left CCA angle and age to distinguish between nonconversion and conversion to TFA were 16° (area under the curve [AUC], 0.93; 95% confidence interval [CI], 0.83-1.00) and 74 years (AUC, 0.79; 95% CI, 0.61-0.96), respectively.
A more acute innominate-left CCA angle and older age appear associated with difficulty delivering the guiding catheter into the left ICA for neurointervention through TRA.
经桡动脉入路（TRA）比经股动脉入路（TFA）侵入性更小，但较高的转换率是一个缺点。在目标血管中，经TRA将导引导管送入左颈内动脉（ICA）特别困难。因此，本研究的目的是客观探索经TRA将导引导管送入左ICA困难程度的解剖学和临床特征。
在2021年3月1日至2022年8月31日期间，在单一机构中通过TRA对78例未破裂颅内动脉瘤进行弹簧圈栓塞的连续患者中，对所有29例（37%）将导引导管送入左ICA的患者进行回顾性分析。分析临床和解剖学特征，以评估与将导管送入左ICA困难程度的相关性。
在29例需要将导管送入左ICA的动脉瘤中，9例（31%）需要从TRA转换为TFA。无名动脉-左颈总动脉（CCA）夹角更锐（<0.001）和年龄较大（=0.015）与更高的TFA转换率相关。受试者操作特征分析显示，区分未转换和转换为TFA的无名动脉-左CCA夹角和年龄的最佳截断值分别为16°（曲线下面积[AUC]，0.93；95%置信区间[CI]：0.83-1.00）和74岁（AUC，0.79；95%CI：0.61-0.96）。
无名动脉-左CCA夹角更锐和年龄较大似乎与经TRA进行神经介入时将导引导管送入左ICA困难相关。
