桡动脉入路与股动脉入路椎动脉起始部支架植入术的效果对比分析

Comparison of effectiveness of stenting for vertebral artery ostium severe stenosis via transradial access and transfemoral access

目的对比分析椎动脉起始部重度狭窄时经桡动脉入路与经股动脉入路行椎动脉支架植入术的效果差异。方法选择武汉市江夏区第一人民医院神经内科自2017年12月至2022年3月收治的63例经脑血管造影证实为椎动脉起始部重度狭窄的患者进行研究,其中经同侧桡动脉穿刺植入支架30例(桡动脉组),经股动脉穿刺植入支架33例(股动脉组)。桡动脉组患者另根据椎动脉病变部位分为左侧亚组与右侧亚组,根据椎动脉解剖分型分为Ⅰ型亚组与Ⅱ型亚组。对比分析桡动脉组与股动脉组患者间基线资料及手术资料(支架植入成功率、置鞘至支架植入时间、手术时间、曝光时间、手术并发症发生率等)的差异,对比分析桡动脉组各亚组患者间手术资料的差异。结果桡动脉组与股动脉组相比,支架植入成功率、术后3 d主要终点事件发生率等的差异均无统计学意义(P>0.05),但置鞘至支架植入时间、手术时间、曝光时间、穿刺点并发症发生率(9.01%vs.30.00%)及穿刺点血肿发生率(3.03%vs.20.05%)均明显降低,差异均有统计学意义(P<0.05)。桡动脉组Ⅱ型亚组与Ⅰ型亚组相比,左侧亚组与右侧亚组相比,置鞘至支架植入时间、手术时间及曝光时间均明显降低,差异均有统计学意义(P<0.05)。结论与经股动脉入路相比,经桡动脉入路实施椎动脉支架植入的手术成功率相当,围手术期严重并发症的发生率无显著差异,但手术用时更短,操作难度更低,穿刺点并发症发生率更低,其中椎动脉解剖分型Ⅱ型较Ⅰ型、左侧病变较右侧的效果更优。

Objective To analyze the differences of effectiveness of stenting for vertebral artery ostium severe stenosis via transradial access and transfemoral access.Methods Sixty-three patients with vertebral artery ostium severe stenosis confirmed by cerebral angiography in our hospital from December 2017 to March 2022 were enrolled.Stent implantation via transradial access was performed in 30 patients(radial artery group)and stent implantation via transfemoral access was performed in 33 patients(femoral artery group).The radial artery group was divided into left and right subgroups according to the lesions of vertebral arteries;and according to the anatomical classification of vertebral arteries,radial artery group was divided into two subgroups:anatomical type I and anatomical type II.The baseline data and surgery-related data(success rate of stent implantation,time from sheath insertion to stent implantation,surgical time,exposure time,and incidence of surgical complications)of patients in the radial artery group and femoral artery group were compared and analyzed.The surgical data of patients in the subgroups of radial artery group were compared and analyzed.Results There was no significant difference in the success rate of stent implantation or incidence of primary endpoint events 3 d after surgery between the radial artery group and femoral artery group(P>0.05).The time from sheath insertion to stent implantation,surgical time,and exposure time in the radial artery group were statistically shorter than those in the femoral artery group(P<0.05).The radial artery group had significantly lower incidence of complications(9.01%vs.30.0%)and incidence of hematoma(3.03%vs.20.05)at the puncture sites than the femoral artery group(P<0.05).Time from sheath insertion to stent implantation,surgical time,and exposure time in the anatomical type I patients of radial artery group were significantly longer than those in the anatomical type II patients(P<0.05);those in patients with left lesions of radial artery group were significantly shorter than those in patients with right lesions(P<0.05).Conclusion As compared with that via transfemoral access,the stenting via transradial access has almost the same success rate,without significant difference in incidence of perioperative serious complications,and stenting via transradial access has shorter surgical time,lower surgical difficulty,and lower incidence of complications;patients with anatomical type II or left lesions have better efficacy than those with anatomical type I or right lesions.