Batista Sávio, Andreão Filipi Fim, Bertani Raphael, de Barros Oliveira Leonardo, Oberman Dan Zimelewicz, Palavani Lucca B, Filho Cesar Augusto Ferreira Alves, de Oliveira Braga Fausto, Machado Elias Antônio Tanus, da Mata Pereira Paulo José, Filho Paulo Niemeyer, Almeida Filho José Alberto
Faculty of Medicine, Federal University of Rio de Janeiro, Brazil.
Department of Neurosurgery, University of São Paulo, Brazil.
Neuroradiol J. 2024 Oct;37(5):564-570. doi: 10.1177/19714009241240328. Epub 2024 Mar 19.
The Woven EndoBridge (WEB) device is a minimally invasive endovascular treatment option for patients with cerebral aneurysms. Transradial access (TRA) is a technique that involves accessing the arterial system through the radial artery in the wrist rather than the femoral artery in the groin. Several studies have investigated the use of TRA for WEB device deployment in treating intracranial aneurysms.
A systematic review was conducted to evaluate the TRA for WEB device deployment in treating intracranial aneurysms. The databases PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. To reduce the risk of bias, this systematic review only included studies reporting on using TRA in WEB device deployment for intracranial aneurysm treatment with a minimum of four patients.
In this systematic review, 186 patients were included across five studies, with TRA used in 183 cases analyzed. The study population had a higher proportion of females ( = 118%-69%) than males, with a mean age of 62 years old. Among the aneurysms treated, 46 were ruptured, and 119 were located at bifurcation sites, with a mean maximum diameter/width of 6.6 mm and mean height of 5.9 mm. Adjunctive coiling was used in three cases, and adjunctive stenting was used in nine cases. In two cases, conversion to a femoral artery access was necessary.
The available results suggest TRA with the WEB device is a safe and effective alternative. However, using TRA versus TFA should be individualized based on patient factors and operator experience.
编织型血管内桥接(WEB)装置是一种用于脑动脉瘤患者的微创血管内治疗选择。经桡动脉入路(TRA)是一种通过手腕部的桡动脉而非腹股沟处的股动脉进入动脉系统的技术。多项研究探讨了TRA在使用WEB装置治疗颅内动脉瘤中的应用。
进行了一项系统评价,以评估TRA在使用WEB装置治疗颅内动脉瘤中的应用。检索了PubMed、Cochrane、Embase、Scopus和Web of Science数据库。为降低偏倚风险,本系统评价仅纳入了至少有4例患者使用TRA进行WEB装置颅内动脉瘤治疗的研究报告。
在本系统评价中,五项研究共纳入186例患者,其中183例分析采用了TRA。研究人群中女性比例(=118%-69%)高于男性,平均年龄为62岁。在治疗的动脉瘤中,46例为破裂动脉瘤,119例位于分叉部位,平均最大直径/宽度为6.6mm,平均高度为5.9mm。3例使用了辅助弹簧圈栓塞,9例使用了辅助支架置入。2例需要转为股动脉入路。
现有结果表明,TRA联合WEB装置是一种安全有效的替代方法。然而,TRA与经股动脉入路(TFA)的选择应根据患者因素和术者经验个体化。