Hanaoka Yoshiki, Koyama Jun-Ichi, Nakamura Takuya, Kitamura Satoshi, Abe Daishiro, Yamazaki Daisuke, Inomata Yuki, Horiuchi Tetsuyoshi
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Nagano, Japan.
Interv Neuroradiol. 2023 Sep 11:15910199231201517. doi: 10.1177/15910199231201517.
We read with great interest the paper titled "Transradial access with Simmons guiding catheter for carotid artery stenting: Feasibility and procedural complications in a single-center experience" by Muszynski et al. The authors concluded that a transradial carotid artery stenting (CAS) using a Glidesheath Slender 7F Introducer/7F Envoy Simmons 2 catheter system was feasible with a high procedural success rate and low access site complication rate. We completely agree with their conclusions. In this study, large-diameter sheaths were used. Large sheaths increase the risk of developing radial artery spasms. Interventionalists must be aware that radial artery spasm can not only require an access crossover, but can also cause severe access site complications, such as eversion or avulsion of the radial artery, catheter/sheath entrapment, and compartment syndrome. A 6F Simmons guiding sheath has a smaller outer diameter than the Glidesheath Slender 7F Introducer does, and it offers a large-bore working channel compatible with a 10-mm diameter Wallstent and Acculink. Transradial CAS with a 6F Simmons guiding sheath has previously yielded a high procedural success rate without serious access site complications. Nevertheless, we believe that a further decrease in the sheath diameter is required to safely perform transradial neurointerventions in more patients.
我们饶有兴趣地阅读了Muszynski等人题为《使用西蒙斯引导导管经桡动脉途径行颈动脉支架置入术：单中心经验中的可行性及操作并发症》的论文。作者得出结论，使用Glidesheath Slender 7F导入器/7F Envoy Simmons 2导管系统经桡动脉行颈动脉支架置入术（CAS）是可行的，操作成功率高且穿刺部位并发症发生率低。我们完全同意他们的结论。在本研究中，使用了大直径鞘管。大鞘管会增加发生桡动脉痉挛的风险。介入医生必须意识到，桡动脉痉挛不仅可能需要更换穿刺部位，还可能导致严重的穿刺部位并发症，如桡动脉外翻或撕裂、导管/鞘管嵌顿以及骨筋膜室综合征。6F西蒙斯引导鞘管的外径比Glidesheath Slender 7F导入器小，并且它提供了一个与直径10毫米的Wallstent和Acculink兼容的大口径工作通道。此前，使用6F西蒙斯引导鞘管经桡动脉行CAS已取得了较高的操作成功率，且无严重的穿刺部位并发症。然而，我们认为需要进一步减小鞘管直径，以便在更多患者中安全地进行经桡动脉神经介入治疗。
