神经介入患者远端桡动脉入路诊疗安全性和可行性

The safety and feasibility of neurointerventional diagnosis and treatment via distal transradial access

目的探讨远端桡动脉入路(dTRA)穿刺在神经介入诊疗中的安全性和可行性。方法回顾性分析2020年10月至2022年3月在北京安贞医院接受dTRA选择性脑血管造影或支架植入术诊疗患者一般资料(年龄、性别、危险因素等)、临床资料(入手术室至穿刺成功时间、手术时间、X线辐射时间、总辐射剂量)、手术相关并发症、穿刺相关并发症。结果共纳入患者34例,其中男26例,女8例,年龄(61.6±9.0)(33~74)岁。dTRA脑血管造影技术成功率为100%。入手术室至穿刺成功时间为(23.1±10.1)(9~50)min,手术时间为(46.1±27.4)(14~154)min,X线辐射时间为(17.7±12.3)(6~69)min,总辐射剂量为(671.6±334.3)(70~1573)mGy。造影完成后17例同期接受介入治疗,其中1例椎动脉起始段狭窄患者造影后拟行椎动脉支架植入术,因路径迂曲改为股动脉穿刺。dTRA行介入治疗技术成功率为94.1%(16/17)。术后24 h 1例颈动脉支架植入术患者出现急性支架内闭塞,急诊取栓后美国国立卫生研究院卒中量表(NIHSS)评分为0分。术后患者未出现穿刺点淤血、出血、血肿及桡动脉闭塞。结论dTRA行神经介入诊断和治疗安全可行。

Objective To investigate the safety and feasibility of performing neurointerventional diagnosis and treatment via distal transradial access(dTRA).Methods The clinical materials of patients,who received selective cerebral angiography or stent implantation at the Affiliated Beijing Anzhen Hospital of Capital Medical University of China between October 2020 and March 2022,were retrospectively analyzed.The clinical materials included the basic data(age,gender,risk factors,etc.),the clinical records(time from entering the operating room to completing successful puncture,time spent for operation,X-ray exposure time,and total radiation dose),the operation-related complications and the puncture-related complications.Results A total of 34 patients were enrolled in this study,including 26 males and 8 females with a mean age of(61.6±9.0)years(range of 33-74 years).The technical success rate of cerebral angiography via dTRA was 100%.The time from entering the operating room to completing successful puncture was(23.1±10.1)min,the time spent for operation was(46.1±27.4)min(range of 14-154 min),the X-ray exposure time was(17.7±12.3)min(range of 6-69 min),the total radiation dose was(671.6±334.3)mGy(range of 70-1573 mGy).After the completion of angiography,17 patients received interventional therapy during the same procedure,one patient among them,who suffered from initial segment stenosis of vertebral artery and was scheduled to carry out vertebral artery stenting,had to adopt femoral artery puncture approach as the vascular path was very tortuous.The success rate of interventional therapy via dTRA was 94.1%(16/17).One patient receiving carotid stenting developed acute in-stent occlusion at 24 hours after surgery,after receiving emergency thrombectomy the patient’s National Institutes of Health Stroke Scale(NIHSS)score was 0 point.No puncture-point site congestion,bleeding,hematoma or radial artery occlusion occurred in all patients.Conclusion It is clinically safe and feasible to adopt dTRA approach for performing neurointerventional diagnosis and treatment.(J Intervent Radiol,2022,31:954-957)