Department of Neurosurgery, Mishuku Hospital, 5-33-12, Kamimeguro, Meguro-ku, Tokyo 153-0051, Japan; Department of Neurosurgery, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama 359-0042, Japan.
Department of Neurosurgery, Mishuku Hospital, 5-33-12, Kamimeguro, Meguro-ku, Tokyo 153-0051, Japan.
Clin Neurol Neurosurg. 2024 Oct;245:108471. doi: 10.1016/j.clineuro.2024.108471. Epub 2024 Jul 26.
Although mechanical thrombectomy (MT) is primarily performed via transfemoral access (TFA), transradial access (TRA) is a potential alternative in older patients or those with tortuous vessels. However, the small radial artery diameter restricts the use of large-bore balloon guides and aspiration catheters, a limitation that may be overcome using the sheathless technique. Thus, we aimed to explore the feasibility, efficacy, and safety of sheathless TRA-MT as a first-line treatment approach for acute ischemic stroke.
This single-center retrospective case series included patients who underwent TRA-MT as first-line treatment between September 2020 and June 2023. Per our MT protocol, TRA was not the first-line approach in cases of left anterior circulation lesions with a type 3 aortic arch. We evaluated treatment effectiveness based on the successful recanalization rate, puncture-to-recanalization time, and modified first-pass effect; access route effectiveness based on the puncture-to-first-pass time and switch-to-TFA rate; and procedure safety based on procedure-related and severe puncture site complications.
Sheathless 8-F guide catheters were used in 68 % and large-bore aspiration catheters in 70 % of the procedures. Successful recanalization was achieved in 98 % of the patients, with a modified first-pass effect in 54 % of them. The median puncture-to-first-pass and puncture-to-recanalization times were 20.5 and 33 min, respectively. The rate of procedure-related complications was low (4 %), with no severe puncture site complications.
Sheathless TRA-MT enabled the use of large-bore guide and aspiration catheters, providing a swift approach to the target and satisfactory outcomes, and might be an effective first-line treatment for acute ischemic stroke.
虽然机械血栓切除术（MT）主要通过经股动脉入路（TFA）进行，但在老年患者或血管迂曲患者中，经桡动脉入路（TRA）是一种潜在的替代方法。然而，较小的桡动脉直径限制了大口径球囊导引导管和抽吸导管的使用，而使用无鞘技术可能会克服这一限制。因此，我们旨在探讨无鞘 TRA-MT 作为急性缺血性脑卒中一线治疗方法的可行性、疗效和安全性。
本单中心回顾性病例系列研究纳入了 2020 年 9 月至 2023 年 6 月期间接受 TRA-MT 作为一线治疗的患者。根据我们的 MT 方案，对于左侧前循环病变且主动脉弓类型为 3 型的患者，TRA 不是首选入路。我们根据成功再通率、穿刺至再通时间和改良的初次通过效果评估治疗效果；根据穿刺至初次通过时间和转为 TFA 率评估入路效果；根据与手术相关的严重穿刺部位并发症评估手术安全性。
在 68%的手术中使用了无鞘 8-F 导引导管，在 70%的手术中使用了大口径抽吸导管。98%的患者实现了成功再通，其中 54%的患者达到了改良的初次通过效果。穿刺至初次通过和穿刺至再通的中位时间分别为 20.5 分钟和 33 分钟。手术相关并发症发生率较低（4%），无严重穿刺部位并发症。
无鞘 TRA-MT 能够使用大口径导引导管和抽吸导管，快速到达目标部位，获得满意的结果，可能是急性缺血性脑卒中的一种有效一线治疗方法。
