Izawa Daisuke, Matsumoto Hiroyuki, Nakanishi Yuta, Nakashima Shouta, Nishiyama Hirokazu
Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.oa.2025-0074. Epub 2025 Aug 30.
The distal transradial approach has been one of the options for endovascular neurointervention because of the low risk of puncture site complications. However, the conventional and distal transradial artery approaches frequently cause cannulation-induced vasospasms, which can usually be prevented by vasodilators. The aim was to evaluate the effects of local infiltration using a puncture site cocktail of lidocaine mixed with nitroglycerin on puncture success and vasospasm for distal transradial cerebral angiography.
A total of 85 consecutive patients who underwent cerebral angiography via distal radial artery puncture between February 2024 and December 2024 were included. Of these patients, 28 patients were excluded due to irregularities. The remaining 57 patients were eligible for this retrospective study and were divided into 2 groups: (1) underwent local anesthesia with 1% lidocaine (n = 23, Lidocaine group); and (2) puncture site cocktail of 1% lidocaine mixed with nitroglycerin (n = 34, Cocktail group). In both groups, patients' characteristics and procedure results were retrospectively assessed. In addition, in all patients, the correlation between the number of punctures and distal radial artery diameter, and the cutoff values of distal radial artery diameters after local anesthesia for 1st puncture success were also assessed.
Patient background characteristics showed no significant differences between the groups. In the procedure results, the mean diameter of the distal radial artery before local anesthesia was significantly smaller in the Cocktail group (2.1 vs 1.7 mm, p <0.05). The mean dilatation rate of the distal radial artery was significantly greater in the Cocktail group than in the Lidocaine group (1.3 vs 1.1, p <0.05); thus, there was no difference in the mean diameter after local anesthesia. The 1st puncture success rate and the mean number of punctures were not significantly different between the 2 groups. The rate of cannulation-induced distal flow arrest was significantly lower in the Cocktail group (47.8% vs 20.6%, p <0.05). Puncture site complications and radial artery occlusions were not observed in either group. There was a negative correlation between distal radial artery diameter after local anesthesia and the number of punctures (r = -0.53, 95% CI: -0.69 to -0.31, p <0.001). The cutoff value for the diameter of the distal radial artery was 1.9 mm.
The puncture site cocktail significantly increases the diameter of the distal radial artery, which may be related to the reduction of cannulation-induced vasospasm without periprocedural complications in cases with a small-diameter distal radial artery.
由于穿刺部位并发症风险较低，经桡动脉远端入路一直是血管内神经介入治疗的选择之一。然而，传统的经桡动脉远端入路常导致插管引起的血管痉挛，通常可用血管扩张剂预防。本研究旨在评估利多卡因与硝酸甘油混合的穿刺部位鸡尾酒局部浸润对经桡动脉远端脑血管造影穿刺成功率和血管痉挛的影响。
纳入2024年2月至2024年12月期间连续85例行经桡动脉远端穿刺脑血管造影的患者。其中，28例患者因不符合标准被排除。其余57例患者符合本回顾性研究要求，分为2组：（1）接受1%利多卡因局部麻醉的患者（n = 23，利多卡因组）；（2）1%利多卡因与硝酸甘油混合的穿刺部位鸡尾酒组（n = 34，鸡尾酒组）。回顾性评估两组患者的特征和手术结果。此外，评估所有患者穿刺次数与桡动脉远端直径之间的相关性，以及首次穿刺成功的局部麻醉后桡动脉远端直径的截断值。
两组患者的背景特征无显著差异。在手术结果方面，鸡尾酒组局部麻醉前桡动脉远端的平均直径明显较小（2.1 vs 1.7 mm，p <0.05）。鸡尾酒组桡动脉远端的平均扩张率明显高于利多卡因组（1.3 vs 1.1，p <0.05）；因此，局部麻醉后的平均直径无差异。两组的首次穿刺成功率和平均穿刺次数无显著差异。鸡尾酒组插管引起的远端血流停滞率明显较低（47.8% vs 20.6%，p <0.05）。两组均未观察到穿刺部位并发症和桡动脉闭塞。局部麻醉后桡动脉远端直径与穿刺次数呈负相关（r = -0.53，95% CI：-0.69至-0.31，p <0.001）。桡动脉远端直径的截断值为1.9 mm。
穿刺部位鸡尾酒可显著增加桡动脉远端直径，这可能与减少插管引起的血管痉挛有关，且在桡动脉远端直径较小的情况下无围手术期并发症。
