Orscelik Atakan, Senol Yigit Can, Kobeissi Hassan, Ghozy Sherief, Bilgin Cem, Arul Santhosh, Kadirvel Ramanathan, Brinjikji Waleed, Kallmes David F
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Interv Neuroradiol. 2023 Nov 7:15910199231210411. doi: 10.1177/15910199231210411.
Distal transradial artery access (dTRA) has received increasing consideration for performing diagnostic cerebral angiography and neurointerventional procedures. In this meta-analysis, we aim to evaluate the safety and efficacy of dTRA compared to conventional transradial access (cTRA) for cerebral angiography and neurointerventions.
A systematic review and meta-analysis were conducted on studies investigating outcomes of dTRA and cTRA in neurointerventions. The primary outcome was technical success rates. Secondary outcomes included access site complication rates, crossover rates to alternative vessels, fluoroscopy time, and contrast volume. The random effects model was used to calculate the mean difference (MD) and odds ratios (OR) with 95% confidence intervals (Cl).
Eight retrospective observational studies with a total of 1477 patients who underwent 1175 diagnostic cerebral angiography and 516 neurointerventional procedures using 546 dTRA and 1164 cTRA approaches were included in our meta-analysis. The technical success rate was similar between dTRA and cTRA groups (95.8% vs 91.4%; OR:1.65; 95% Cl: 0.52 to 5.22; P = 0.40). Similarly, no difference was seen in dTRA and cTRA regarding access site complications (2% vs 1.4%; OR: 1.31; 95% CI: 0.47 to 3.61; P = 0.61) and access site crossover (2.1% vs 5.3%; OR: 0.55; 95% Cl: 0.28 to 1.05; P = 0.07). After resolving heterogeneity among included studies, dTRA was associated with a shorter fluoroscopy time (MD: -0.91 min; 95% CI: -1.74 to -0.09; P = 0.03) and lower contrast volume (MD: -8.32 mL; 95% CI = -14.7 to -1.94; P = 0.011).
Our findings suggest that the dTRA approach is a safe and effective alternative to the cTRA approach in patients undergoing cerebral angiography and neurointerventions.
远端桡动脉入路（dTRA）在进行诊断性脑血管造影和神经介入手术中受到越来越多的关注。在这项荟萃分析中，我们旨在评估与传统桡动脉入路（cTRA）相比，dTRA用于脑血管造影和神经介入的安全性和有效性。
对研究dTRA和cTRA在神经介入中结局的研究进行系统评价和荟萃分析。主要结局是技术成功率。次要结局包括穿刺部位并发症发生率、改用其他血管的交叉率、透视时间和造影剂用量。采用随机效应模型计算平均差（MD）和比值比（OR）以及95%置信区间（Cl）。
我们的荟萃分析纳入了8项回顾性观察性研究，共1477例患者，他们使用546例dTRA和1164例cTRA方法进行了1175例诊断性脑血管造影和516例神经介入手术。dTRA组和cTRA组的技术成功率相似（95.8%对91.4%；OR：1.65；95%Cl：0.52至5.22；P = 0.40）。同样，dTRA和cTRA在穿刺部位并发症（2%对1.4%；OR：1.31；95%CI：0.47至3.61；P = 0.61）和穿刺部位交叉率（2.1%对5.3%；OR：0.55；95%Cl：0.28至1.05；P = 0.07）方面没有差异。在解决纳入研究之间的异质性后，dTRA与较短的透视时间（MD：-0.91分钟；95%CI：-1.74至-0.09；P = 0.03）和较低的造影剂用量（MD：-8.32毫升；95%CI = -14.7至-1.94；P = 0.011）相关。
我们的研究结果表明，在进行脑血管造影和神经介入的患者中，dTRA方法是cTRA方法的一种安全有效的替代方法。
