经桡动脉入路在老年脑血管造影中的应用及主动脉弓形态学影响因素分析

Transradial cerebral angiography in elderly patients and relevant morphometric parameters of the aortic arch

目的探讨老年患者经桡动脉入路脑血管造影的优势以及主动脉弓形态学参数对其影响。方法回顾性纳入2022年5月至2023年4月在北京医院神经外科接受单纯全脑血管造影术患者的临床资料和主动脉弓CT血管造影(CTA)影像参数,分析老年患者经桡动脉入路相较年轻患者、经股动脉入路造影用时的差异,以及相关的主动脉弓形态学参数。结果共纳入101例患者的数据,其中男性67例(66.3%),年龄(63.4±12.0)岁,60岁及以上老年人69例(68.3%);经桡动脉入路44例(43.6%),股动脉入路57例(56.4%)。老年患者中Ⅰ、Ⅱ、Ⅲ型主动脉弓分别有14例(20.6%)、31例(45.6%)、23例(33.8%),年轻患者中相应例数分别为17例(53.1%)、12例(37.5%)、3例(9.4%),分布差异有统计学意义(χ^(2)=12.765,P=0.002);老年患者主动脉弓宽度角较年轻患者更大(106°±12°比100°±12°,t=2.334,P=0.022)。对于老年患者,经桡动脉行全脑血管造影用时较经股动脉入路为短[(39.8±29.5)min和(52.2±28.4)min,t=1.845,P=0.070];而对于年轻患者,两种入路无差异[经桡动脉和股动脉入路平均用时分别为(42.3±30.4)min和(34.6±11.2)min,t=1.026,P=0.313]。对于Ⅱ型主动脉弓组,经桡动脉入路和经股动脉入路平均用时分别为(38.1±21.7)min和(46.7±32.2)min(t=1.020,P=0.314),Ⅲ型主动脉弓组两者平均用时分别为(41.9±37.3)min和(48.9±20.7)min(t=0.542,P=0.598)。相关性分析显示,经桡动脉入路全脑血管造影用时与头臂干和左锁骨下动脉起始部的距离呈负相关(r=-0.372,P=0.014)。结论对于老年患者,特别是Ⅱ、Ⅲ型主动脉弓或主动脉弓较宽者,经桡动脉入路脑血管造影用时较经股动脉入路更有优势;经桡动脉入路中,头臂干和左锁骨下动脉起始部的距离是全脑血管造影用时的显著影响因素。

Objective To explore the benefits of transradial diagnostic cerebral angiography in elderly patients and its correlation with morphometric parameters of the aortic arch.Methods Clinical data and aortic arch CTA imaging parameters of patients who underwent cerebral angiography at the Department of Neurosurgery,Beijing Hospital,between May 2022 and April 2023 were retrospectively analyzed.The study aimed to compare the time taken for angiography via radial artery access in elderly patients versus younger patients,as well as via femoral artery access,and to evaluate the associated aortic arch morphology parameters.Results A total of 101 patients'data were analyzed,with 67 males(66.3%)and an average age of 63.4±12.0 years.Among them,69 patients(68.3%)were aged 60 and above.The arterial approach for 44 patients(43.6%)was radial,while 57 cases(56.4%)used the femoral artery approach.In the elderly group,14 cases(20.6%),31 cases(45.6%),and 23 cases(33.8%)had typeⅢaortic arch,respectively.For younger patients,17 cases(53.1%),12 cases(37.5%),and 3 cases(9.4%)fell into these categories.The distribution difference was statistically significant(χ^(2)=12.765,P=0.002).Elderly patients had a larger aortic arch width angle compared to younger patients(106°±12°and 100°±12°,t=2.334,P=0.022).The time for whole-brain angiography via radial artery was shorter for elderly patients than via femoral artery(39.8±29.5 minutes and 52.2±28.4 minutes,respectively,t=1.845,P=0.070).In young patients,there was no significant time difference between the two approaches(42.3±30.4 minutes for radial artery and 34.6±11.2 minutes for femoral artery,t=1.026,P=0.313).In the typeⅡaortic arch group,the average times for transradial and transfemoral approaches were 38.1±21.7 minutes and 46.7±32.2 minutes,respectively(t=1.020,P=0.314).The average times for the typeⅢaortic arch group were 41.9±37.3 minutes and 48.9±20.7 minutes,respectively.Correlation analysis revealed a significant negative correlation between the duration of radial artery access and the distance from the origin of the innominate artery to the left subclavian artery(Pearson correlation coefficien(r=-0.372,P=0.014).Conclusions In elderly patients,particularly those with typeⅡorⅢaortic arch or a wide aortic arch,diagnostic cerebral angiography using transradial access is preferable to femoral access.The distance between the innominate artery and the left subclavian artery origin could impact the duration of the procedure.