Imahori Taichiro, Miyake Shigeru, Maeda Ichiro, Goto Hiroki, Nishii Rikuo, Enami Haruka, Yamamoto Daisuke, Harada Tomoaki, Tanaka Jun, Sakata Junichi, Hamaguchi Hirotoshi, Sakai Nobuyuki, Sasayama Takashi, Hosoda Kohkichi
Department of Neurosurgery, Kitaharima Medical Center, Ono 675-1392, Hyogo, Japan.
Department of Neurovascular Research, Kobe City Medical Center General Hospital, Kobe 650-0047, Hyogo, Japan.
J Clin Med. 2024 Dec 6;13(23):7432. doi: 10.3390/jcm13237432.
Carotid artery stenting (CAS) has traditionally been performed using the transfemoral approach (TFA). Recently, the transradial approach (TRA) has gained attention for its lower invasiveness and reduced complication risk. This study compares outcomes between two access strategy timeframes, TFA-first and TRA-first, to evaluate how this shift influences outcomes in a real-world setting. A retrospective analysis of 85 CAS procedures was conducted at our institution from October 2018 to September 2024, categorizing them into TFA-first (n = 42) and TRA-first (n = 43) periods. The primary endpoint was access-related complications and 30-day perioperative events, including stroke, myocardial infarction, and mortality. The secondary endpoints included target lesion access success rate, frequency of access route conversions, procedural time, and hospital length of stay. Baseline characteristics, including age, sex, symptomatic status, stenosis severity, plaque characteristics, and anatomical considerations, were comparable between groups. In the TFA-first period, 88% of procedures utilized TFA, and TRA was not used at all, while the remaining 12% employed the transbrachial approach (TBA). In the TRA-first period, 23% of procedures employed TFA, 60% utilized TRA, and 16% relied on TBA ( < 0.01). Both groups achieved a similar rate of target lesion access success (98% each) with only one conversion per group. The primary endpoint was significantly lower in the TRA-first group (0%) compared to the TFA-first group (10%, = 0.04), primarily due to reduced access-site complications. Additionally, the median hospital stay was shorter in the TRA-first group at 6 days compared to 10 days ( = 0.02). Adopting a TRA-first strategy over TFA in CAS leads to better outcomes by improving access-site safety and reducing hospital stays. Developing TRA-specific devices could further expand the applicability of TRA in CAS.
传统上，颈动脉支架置入术（CAS）采用经股动脉途径（TFA）进行。最近，经桡动脉途径（TRA）因其较低的侵入性和降低的并发症风险而受到关注。本研究比较了两种入路策略时间框架（先TFA和先TRA）之间的结果，以评估这种转变在现实环境中如何影响结果。2018年10月至2024年9月在我们机构对85例CAS手术进行了回顾性分析，将它们分为先TFA组（n = 42）和先TRA组（n = 43）。主要终点是与入路相关的并发症和30天围手术期事件，包括中风、心肌梗死和死亡率。次要终点包括靶病变入路成功率、入路途径转换频率、手术时间和住院时间。两组之间的基线特征，包括年龄、性别、症状状态、狭窄严重程度、斑块特征和解剖学因素，具有可比性。在先TFA组中，88%的手术使用TFA，完全未使用TRA，其余12%采用经肱动脉途径（TBA）。在先TRA组中，23%的手术采用TFA，60%使用TRA，16%依赖TBA（<0.01）。两组的靶病变入路成功率相似（每组均为98%），每组仅1例转换。先TRA组的主要终点（0%）显著低于先TFA组（10%，P = 0.04），主要是由于入路部位并发症减少。此外，先TRA组的中位住院时间为6天，短于先TFA组的10天（P = 0.02）。在CAS中采用先TRA策略而非TFA可通过提高入路部位安全性和缩短住院时间带来更好的结果。开发TRA专用设备可进一步扩大TRA在CAS中的适用性。
