Horiguchi Satoshi, Maki Yoshinori, Satow Takeshi, Mitsuno Yuto, Nakajima Kota
Department of Neurosurgery, Nagahama City Hospital, Nagahama, Shiga, Japan.
Department of Neurosurgery, Hikone Chuo Hospital, Hikone, Shiga, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.cr.2025-0008. Epub 2025 May 15.
Cardiologists use the distal radial artery (dRA) approach in daily clinical practice. This method is gradually being applied in neuroendovascular treatment. However, limited studies have been reported concerning tumor embolization using small-bore guidance via dRA.
Five consecutive tumoral cases underwent endovascular embolization via the dRA approach. The right dRA was punctured, with manual confirmation of pulsation or under the guidance of ultrasonography, using a 22-G plastic cannulation needle. After the insertion of a 0.021-inch guidewire, a dilator of a 4-Fr sheath enlarged the puncture site. The 22-G plastic cannulation needle was replaced with an 18-G cannulation needle, and a 0.035 guidewire was inserted to introduce a small-bore guide. A TEMPO4 (Cordis, Miami Lakes, FL, USA; outer diameter: 1.35 mm) or a 3.6-Fr JB2 (Gadelius Medical, Tokyo, Japan; outer diameter: 1.2 mm) was used in 4 cases to convey embolization materials, whereas a 4-Fr, 16-cm sheath (Terumo, Tokyo, Japan; outer diameter: 2 mm) combined with a 4-Fr SY3 (Gadelius Medical; outer diameter: 1.4 mm) was used in 1 case. Trisacryl gelatin microspheres or -butyl-2-cyanoacrylate were used as embolization materials. Hemostasis was achieved with PreludeSYNC DISTAL (Merit Medical, South Jordan, UT, USA), and the median time ± standard deviation of hemostasis was 2.00 ± 0.77 h. No complications occurred after embolization.
Tumor embolization using small-bore guide via the dRA approach was completed without any complications.
心脏病专家在日常临床实践中使用桡动脉远端（dRA）入路。这种方法正逐渐应用于神经血管内治疗。然而，关于使用小口径引导经dRA进行肿瘤栓塞的研究报道有限。
连续5例肿瘤患者接受了经dRA入路的血管内栓塞治疗。使用22G塑料套管针在超声引导下或手动确认搏动后穿刺右侧dRA。插入0.021英寸导丝后，用4F鞘的扩张器扩大穿刺部位。将22G塑料套管针换成18G套管针，插入0.035导丝以引入小口径引导导管。4例使用TEMPO4（美国佛罗里达州迈阿密湖科迪斯公司；外径：1.35mm）或3.6F JB2（日本东京加德柳斯医疗公司；外径：1.2mm）输送栓塞材料，1例使用4F、16cm鞘（日本东京泰尔茂公司；外径：2mm）与4F SY3（加德柳斯医疗公司；外径：1.4mm）联合使用。使用三丙烯酸明胶微球或丁基-2-氰基丙烯酸酯作为栓塞材料。使用PreludeSYNC DISTAL（美国犹他州南乔丹市美德医疗公司）实现止血，止血的中位时间±标准差为2.00±0.77小时。栓塞后未发生并发症。
经dRA入路使用小口径引导导管进行肿瘤栓塞，未出现任何并发症。
