经桡动脉与股动脉入路血管内治疗颅内动脉瘤的对比研究

Comparative study of endovascular treatment of intracranial aneurysms through radial artery and femoralarteryapproaches

目的对比评价采用经桡动脉入路(TRA)与经股动脉入路(TFA)血管内治疗颅内动脉瘤的安全性及可行性。方法回顾性分析2022年3-8月山东大学齐鲁医院神经外科采用血管内治疗的颅内动脉瘤患者的临床资料,共118例,其中采用TRA51例,采用TFA67例。两组患者的年龄、性别、相关疾病史、动脉瘤特征等的差异均无统计学意义(均P>0.05)。比较两组患者的穿刺成功时间、工作入路角度、指引导管到位时间、手术时间、即刻栓塞效果、患者手术时舒适度评分、手术相关并发症(穿刺点假性动脉瘤、术中血栓形成、支架内血栓形成、症状性脑梗死)的差异。结果两组患者均手术成功,无一例术中更换入路。TRA组与TFA组的工作入路角度[M(Q_(1),Q_(3))]分别为45(33,62)°59(50,68)°,指引导管到位时间[M(Q_(1),Q_(3))]分别为12(8,20)min、9(7,10)min,患者舒适度评分[M(Q_(1),Q_(3))]分别为93(89,98)分、73(68,76)分,差异均有统计学意义(均P<0.05)。而穿刺时间、动脉瘤栓塞效果及手术相关并发症发生率的差异均无统计学意义(均P>0.05)。结论与TFA相比,采用TRA血管内治疗颅内动脉瘤安全可行,在患者舒适度方面更具优势。

Objective To comparatively evaluate the safety and feasibility of endovascular treatment of intracranial aneurysms using transradial approach(TRA)and transfemoral approach(TFA).Methods A retrospective analysis was performed on the clinical data of patients with intracranial aneurysms who underwent endovascular treatment at the Department of Neurosurgery,Qilu Hospital of Shandong University from March to August 2022.There were a total of 118 cases,of which 51 cases received TRA and 67 cases received TFA.There were no statistically significant differences in age,gender,history of related diseases,or aneurysm characteristics between the two groups of patients(all P>0.05).We then compared the puncture success time,working approach angle,guiding catheter placement time,operation time,immediate embolization effect,patient comfort score during operation,and perioperativecomplications(pseudoaneurysm at the puncture point,intraoperative thrombosis,stent thrombosis,symptomatic cerebral infarction)between the two groups of patients.Results The operations were successful for both groups of patients,and no change of surgical approach occurred.The working approach angles[M(Q_(1),Q_(3))]of the TRA group and TFA were 45°(33°,62°)and 59°(50°,68°)respectively,the guiding catheter placement time[M(Q_(1),Q_(3))]were 12(8,20)min,9(7,10)min respectively,the patient comfort scores[M(Q_(1),Q_(3))]were 93(89,98)points and 73(68,76)points respectively,and the differences were statistically significant(all P<0.05).The differences in puncture time,embolization effect or incidence of perioperative complications were not statistically significant(all P>0.05).Conclusion Compared with TFA,endovascular treatment of intracranial aneurysms with TRA is safe,feasible and more advantageous in patient comfort.