Cao Wei, Hu Rongguo, Tang Si Zhao, Jia Dandan, Zhu Deyuan, Qi Dayong, Zhang Kangqing, Song Tonghui, Fang Yibin
Department of Neurovascular Disease, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai 200434, China.
Department of Neurovascular Disease, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai 200434, China.
J Clin Neurosci. 2025 Sep;139:111400. doi: 10.1016/j.jocn.2025.111400. Epub 2025 Jun 27.
The presence of radial artery loops - complete 360° loop along the radial artery, can complicate transradial approach (TRA) in neurointerventional surgeries. Our study aims to evaluate the safety profile of TRA in patients with radial artery loops and proposes strategies for managing radial artery loops to improve the success rate of TRA.
This is a single-center retrospective study, which included all patients with radial artery loops who underwent neurointerventional procedures via TRA over 4 years (2021-2024). Data on baseline patient characteristics, relevant TRA anatomical data, periprocedural complications (e.g. vessel wall injury e.g. perforation), conversion to femoral access, radial artery patency at 3 months follow-up were collected.
Radial artery loops were present in 29 patients from TRA database (total of 945 patients). The average age of patients was 75.5 years old (13 males, 16 females). TRA was successful in 27 out of 29 patients (93.1 %). Radial artery perforation occurred in 2 patients (6.9 %), both managed conservatively with manual compression. At the 3-month follow-up, radial artery patency was preserved in all cases.
TRA in patients with radial artery loops is feasible with a favorable safety profile when appropriate techniques are employed. However, the observed 7% rate of radial artery perforation highlights the need for careful case selection and emphasizes that loop navigation should be reserved for centers with sufficient expertise and clinical justification. Reinforcing the role of preliminary ultrasound screening, particularly when extended proximally, may help identify anatomical variants such as radial loops in advance, thereby reducing procedural complexity and improving planning.
桡动脉袢的存在——沿桡动脉完整的360°袢，会使神经介入手术中的经桡动脉入路（TRA）变得复杂。我们的研究旨在评估TRA在有桡动脉袢患者中的安全性，并提出处理桡动脉袢的策略以提高TRA的成功率。
这是一项单中心回顾性研究，纳入了4年（2021 - 2024年）期间所有通过TRA进行神经介入手术的有桡动脉袢的患者。收集了患者基线特征、相关TRA解剖数据、围手术期并发症（如血管壁损伤，如穿孔）、转为股动脉入路以及3个月随访时桡动脉通畅情况的数据。
TRA数据库中的945例患者中有29例存在桡动脉袢。患者平均年龄为75.5岁（男性13例，女性16例）。29例患者中有27例TRA成功（93.1%）。2例患者（6.9%）发生桡动脉穿孔，均通过手动压迫保守处理。在3个月随访时，所有病例桡动脉均保持通畅。
当采用适当技术时，TRA在有桡动脉袢的患者中是可行的，且安全性良好。然而，观察到的7%的桡动脉穿孔率凸显了仔细选择病例的必要性，并强调袢的导航应仅适用于有足够专业知识和临床依据的中心。加强初步超声筛查的作用，特别是当近端延长时，可能有助于提前识别诸如桡动脉袢等解剖变异，从而降低手术复杂性并改善规划。
