Fuga Michiyasu, Sano Tohru, Hataoka Shunsuke, Ishibashi Toshihiro, Kan Issei, Aoki Ken, Tachi Rintaro, Kato Naoki, Nagayama Gota, Murayama Yuichi
Department of Neurosurgery, The Jikei University School of Medicine, Tokyo , Japan.
Department of Neurosurgery, The Jikei University School of Medicine, Katsushika Medical Center, Tokyo , Japan.
Oper Neurosurg (Hagerstown). 2025 Mar 1;28(3):368-378. doi: 10.1227/ons.0000000000001307. Epub 2024 Aug 12.
Radial artery diameter may limit whether a guiding sheath (GS) can be used via transradial artery access (TRA). A smaller GS may reduce the risk of access site-related complications. This study investigated the feasibility and safety of endovascular treatment (EVT) using a straight-shaped 3-Fr GS (Axcelguide; Medikit).
Patients who underwent EVT with a straight-shaped 3-Fr GS at 3 institutions between April 2022 and March 2024 were retrospectively reviewed. Patient background, anatomic and procedural factors, and complications were recorded.
Twenty-six pathologies were treated with EVT using a 3-Fr GS. Median radial artery diameter was 1.9 mm, and distal TRA (73.1%) was selected more often than TRA (26.9%) as the access site. The breakdown of target pathologies and the role of the 3-Fr GS were as follows: 12 unruptured cerebral aneurysms for intra-aneurysmal coiling, with 5 dural arteriovenous fistulas, 5 brain or head and neck tumors, 2 chronic subdural hematoma, 1 arteriovenous malformation, and 1 hereditary hemorrhagic telangiectasia for transarterial embolization. A success rate of 96.2% was achieved, with no access site- or non-access site-related complications observed within 30 days.
The straight-shaped 3-Fr GS may be applicable for selected pathologies, allowing access even with RAs <2 mm in diameter and facilitating EVT without complications. Preliminary experience with the 3-Fr GS via TRA demonstrated excellent feasibility and safety.
桡动脉直径可能会限制是否能够经桡动脉途径（TRA）使用导引导管（GS）。较小的GS可能会降低与穿刺部位相关并发症的风险。本研究探讨了使用直型3F GS（Axcelguide；Medikit）进行血管内治疗（EVT）的可行性和安全性。
回顾性分析了2022年4月至2024年3月期间在3家机构接受直型3F GS进行EVT的患者。记录患者背景、解剖和操作因素以及并发症。
使用3F GS对26种病变进行了EVT治疗。桡动脉中位直径为1.9mm，作为穿刺部位，远端TRA（73.1%）的选择频率高于TRA（26.9%）。目标病变的分类及3F GS的作用如下：12例未破裂脑动脉瘤行瘤内栓塞，5例硬脑膜动静脉瘘，5例脑或头颈部肿瘤，2例慢性硬膜下血肿，1例动静脉畸形，1例遗传性出血性毛细血管扩张症行经动脉栓塞。成功率达到96.2%，30天内未观察到与穿刺部位或非穿刺部位相关的并发症。
直型3F GS可能适用于特定病变，即使在直径<2mm的桡动脉情况下也能实现穿刺，并有助于无并发症地进行EVT。经TRA使用3F GS的初步经验显示出极佳的可行性和安全性。
