Gao Yang, Liu Bin, Yang Hantao, Wang Guiping, Huang Jinlong, Li Chen, Zhao Puyuan, Yang Liangliang, Yang Zhigang
Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China.
Department of Neurology, Minhang Central Hospital, Shanghai, China; Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
World Neurosurg. 2024 Jan;181:e411-e421. doi: 10.1016/j.wneu.2023.10.071. Epub 2023 Oct 17.
Evaluate the efficacy, safety, and patient satisfaction of transradial access (TRA) compared with conventional transfemoral access (TFA) for diagnostic cerebral angiography in elderly patients (≥65 years of age).
We performed a retrospective review of patients receiving cerebral angiography via TRA or TFA between October 2020 and December 2021 at 3 institutions. Basic patient characteristics, angiographic data, postoperative complications, and patient satisfaction were collected for analysis.
Of the 357 enrolled elderly patients, 175 were performed through TRA and 182 were performed through TFA. There was no significant difference in mean fluoroscopy time (8.6 ± 3.8 minutes vs. 9.1 ± 3.1 minutes; P = 0.103) and radiation exposure (47.7 ± 10.8 Gy-cm vs. 49.8 ± 11.3 Gy-cm; P = 0.068) between the TRA and TFA groups. However, the TRA group had a shorter procedural time (54.7 ± 6.2 minutes vs. 61.1 ± 5.6 minutes; P < 0.001) and less contrast agent (83.2 ± 28.1 mL vs. 100.1 ± 26.2 mL; P < 0.001) than the TFA group. In terms of safety, the incidence of minor vascular access complications in the TRA group was lower than that in the TFA group (1.7% vs. 8.8%; P = 0.003). The incidence of serious complications and neurologic complications in the TRA group was also lower, although the difference was not statistically significant. Overall patient satisfaction was higher in the TRA group than that in the TFA group.
TRA was an efficient and safe alternative to conventional TFA in elderly patients who underwent diagnostic cerebral angiography and who underwent TRA were more satisfied. Findings supported the radial-first strategy for cerebral angiography in elderly populations.
评估老年患者（≥65岁）诊断性脑血管造影中经桡动脉入路（TRA）相较于传统经股动脉入路（TFA）的有效性、安全性及患者满意度。
我们对2020年10月至2021年12月期间在3家机构接受TRA或TFA脑血管造影的患者进行了回顾性研究。收集基本患者特征、血管造影数据、术后并发症及患者满意度进行分析。
在357名纳入研究的老年患者中，175例通过TRA进行，182例通过TFA进行。TRA组和TFA组之间的平均透视时间（8.6±3.8分钟对9.1±3.1分钟；P = 0.103）和辐射暴露（47.7±10.8 Gy-cm对49.8±11.3 Gy-cm；P = 0.068）无显著差异。然而，TRA组的手术时间较短（54.7±6.2分钟对61.1±5.6分钟；P < 0.001），造影剂用量较少（83.2±28.1 mL对100.1±26.2 mL；P < 0.001）。在安全性方面，TRA组轻微血管入路并发症的发生率低于TFA组（1.7%对8.8%；P = 0.003）。TRA组严重并发症和神经并发症的发生率也较低，尽管差异无统计学意义。TRA组的总体患者满意度高于TFA组。
在接受诊断性脑血管造影的老年患者中，TRA是传统TFA的一种有效且安全替代方法，接受TRA的患者更满意。研究结果支持在老年人群中脑血管造影采用桡动脉优先策略。
