机械取栓术中桡动脉与股动脉入路：对临床实践的影响——一项系统评价与荟萃分析

Radial vs femoral access in mechanical thrombectomy: Implications for clinical practice - A systematic review and meta-analysis.

作者信息

Mortezaei Ali, Abdelsalam Ahmed, Oladaskari Alireza, Azzam Ahmed Y, Tran MEng Christina, Sanikommu Sai, Eatz Tiffany, Silva Michael A, Guada Luis, Roach Caleigh S, Toledo Jayro, Kohli Gurkirat Singh, Schartz Derrek, Dmytriw Adam A, Rahmani Redi, Bender Matthew, Starke Robert M

机构信息

Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran. Electronic address: https://twitter.com/AliMortezaei97.

Department of Neurological Surgery, Radiology, Neurosciences, Pharmacology, University of Miami School of Medicine, Miami, FL, USA. Electronic address: https://twitter.com/AbdelsalamMd.

出版信息

J Neuroradiol. 2025 Jun 1;52(5):101356. doi: 10.1016/j.neurad.2025.101356.

DOI:10.1016/j.neurad.2025.101356

PMID:40460972

Abstract

BACKGROUND

Multiple studies have demonstrated lower access complications associated with transradial access (TRA) compared to transfemoral access (TFA) for endovascular procedures. The feasibility and safety of TRA versus TFA for mechanical thrombectomy (MT) for large vessel occlusions in acute ischemic stroke (AIS) is a subject of current debate.

METHODS

We performed a systematic search in four databases. Binary outcomes were analyzed through odds ratios (OR) and 95 % confidence intervals (CI), while the continuous outcomes were analyzed through the standardized mean difference (SMD) and 95 % CI. Publication bias was visually assessed with a funnel plot and confirmed by Egger's test.

RESULTS

There were 5048 total patients undergoing MT from 15 studies in our analyses. In these patients, 984 MT were via TRA and 4064 via TFA. Access-site complications (OR = 0.16, P-value < 0.01) was significantly lower in TRA than TFA. No significant difference was found in 90-day functional independence (mRS 0-2) in the primary analysis (OR = 0.83, P = 0.23), although sensitivity analysis indicated significant difference after resolving heterogeneity. There were no statistically significant distinctions observed between the TRA group and TFA group concerning successful recanalization (OR = 1.07, P-value = 0.5), access-to-reperfusion time (MD = -2.4, P-value = 0.43), first-pass effect (OR = 0.84, P-value = 0.06), mean number of passes (MD = 0.032, P-value = 0.66), symptomatic intracerebral hemorrhage (OR = 0.95, P-value = 0.8), and 90-day mortality (OR = 1.24, P-value = 0.28).

CONCLUSION

TRA was associated with fewer access-site complications compared to TFA. Although no significant difference in 90-day functional independence was observed in the primary meta-analysis, sensitivity analysis indicated potential superiority of TFA. Our findings highlighted optimizing the patient selection to maximize the benefits of thrombectomy through radial access. Further randomized trials and prospective studies are required to confirm these findings.

摘要

背景

多项研究表明，与经股动脉入路（TFA）相比，经桡动脉入路（TRA）用于血管内手术时的入路相关并发症更少。对于急性缺血性卒中（AIS）大血管闭塞的机械取栓术（MT），TRA与TFA的可行性和安全性是当前争论的焦点。

方法

我们在四个数据库中进行了系统检索。二元结局通过比值比（OR）和95%置信区间（CI）进行分析，连续结局通过标准化均值差（SMD）和95%CI进行分析。通过漏斗图直观评估发表偏倚，并通过Egger检验进行确认。

结果

在我们的分析中，共有来自15项研究的5048例患者接受了MT。在这些患者中，984例通过TRA进行MT，4064例通过TFA进行MT。TRA的入路部位并发症（OR = 0.16，P值<0.01）显著低于TFA。在初步分析中，90天功能独立性（改良Rankin量表评分0 - 2分）未发现显著差异（OR = 0.83，P = 0.23），尽管敏感性分析表明在解决异质性后存在显著差异。在成功再通（OR = 1.07，P值 = 0.5）、入路至再灌注时间（MD = -2.4，P值 = 0.43）、首过效应（OR = 0.84，P值 = ）、平均通过次数（MD = 0.032，P值 = 0.66）、症状性脑出血（OR = 0.95，P值 = 0.8）和90天死亡率（OR = 1.24，P值 = 0.28）方面，TRA组和TFA组之间未观察到统计学上的显著差异。

结论

与TFA相比，TRA的入路部位并发症更少。尽管在初步荟萃分析中未观察到90天功能独立性的显著差异，但敏感性分析表明TFA可能具有优势。我们的研究结果强调了优化患者选择以通过桡动脉入路最大化取栓术的益处。需要进一步的随机试验和前瞻性研究来证实这些发现。（注：原文中“OR = 0.84, P值 = ”处P值数据缺失，翻译时保留原文格式）