Qiu Kai, Liu Xinglong, Jia Zhenyu, Zhao Linbo, Shi Haibin, Liu Sheng
Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China.
Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China.
Acad Radiol. 2025 Jan;32(1):326-333. doi: 10.1016/j.acra.2024.06.042. Epub 2024 Jul 10.
This study aimed to evaluate the safety and effectiveness of transbrachial access (TBA) and transradial access (TRA) compared to transfemoral access (TFA) for large-bore neuro stenting (≥7 F).
From January 2019 to January 2024, 4752 patients received large-bore neuro stenting in our center. The primary outcomes were procedural metrics. Safety outcomes were significant access site complications, including substantial hematoma, pseudoaneurysm, artery occlusion, and complications requiring treatment (medicine, intervention, or surgery). After propensity score matching with a ratio of 1:1:2 (TBA: TRA: TFA), adjusting for age, gender, aortic arch type, and neuro stenting as covariates, outcomes were compared between groups.
46 TBA, 46 TRA and 92 TFA patients were enrolled. The mean age was 67.8 ± 11.2 years, comprising 127 (69.0%) carotid artery stenting and 57 (31.0%) vertebral artery stenting. The rates of technical success (TBA: 100%, TRA: 95.7%, TFA: 100%) and significant access site complications (TBA: 4.3%, TRA: 6.5%, TFA: 1.1%) were comparable between the groups (P > 0.05). Compared to TFA, the TRA cohort exhibited significant delays in angiosuite arrival to puncture time (14 vs. 8 min, P = 0.039), puncture to angiography completion time (19 vs. 11 min, P = 0.027), and procedural duration (42 vs. 29 min, P = 0.031). There were no substantial differences in procedural time metrics between TBA (10, 14, and 31 min, respectively) and TFA.
TBA and TRA as the primary access for large-bore neuro stenting are safe and effective. Procedural delays in TRA may favor TBA as the first-line alternative access to TFA.
本研究旨在评估经肱动脉入路（TBA）和经桡动脉入路（TRA）与经股动脉入路（TFA）相比，用于大口径神经支架置入术（≥7F）的安全性和有效性。
2019年1月至2024年1月，4752例患者在本中心接受了大口径神经支架置入术。主要结局为手术指标。安全结局为严重的穿刺部位并发症，包括大量血肿、假性动脉瘤、动脉闭塞以及需要治疗（药物、介入或手术）的并发症。在按1:1:2的比例（TBA:TRA:TFA）进行倾向评分匹配后，将年龄、性别、主动脉弓类型和神经支架置入术作为协变量进行调整，比较各组之间的结局。
纳入46例TBA患者、46例TRA患者和92例TFA患者。平均年龄为67.8±11.2岁，其中127例（69.0%）为颈动脉支架置入术，57例（31.0%）为椎动脉支架置入术。各组之间的技术成功率（TBA：100%，TRA：95.7%，TFA：100%）和严重穿刺部位并发症发生率（TBA：4.3%，TRA：6.5%，TFA：1.1%）相当（P>0.05）。与TFA相比，TRA队列在血管造影室到达穿刺时间（14分钟对8分钟，P=0.039）、穿刺至血管造影完成时间（19分钟对11分钟，P=0.027）和手术持续时间（42分钟对29分钟，P=0.031）方面有显著延迟。TBA（分别为10、14和31分钟）与TFA在手术时间指标上无显著差异。
TBA和TRA作为大口径神经支架置入术的主要入路是安全有效的。TRA的手术延迟可能使TBA成为TFA的一线替代入路。
