Abstract：
BACKGROUND: With transradial access (TRA) being more progressively used in neuroendovascular procedures, we compared TRA with transfemoral access (TFA) in middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH).
METHODS: Consecutive patients undergoing MMAE for cSDH at 14 North American centers (2018-23) were included. TRA and TFA groups were compared using propensity score matching (PSM) controlling for: age, sex, concurrent surgery, previous surgery, hematoma thickness and side, midline shift, and pretreatment antithrombotics. The primary outcome was access site and overall complications, and procedure duration; secondary endpoints were surgical rescue, radiographic improvement, and technical success and length of stay.
RESULTS: 872 patients (median age 73 years, 72.9% men) underwent 1070 MMAE procedures (54% TFA vs 46% TRA). Access site hematoma occurred in three TFA cases (0.5%; none required operative intervention) versus 0% in TRA (P=0.23), and radial-to-femoral conversion occurred in 1% of TRA cases. TRA was more used in right sided cSDH (58.4% vs 44.8%; P<0.001). Particle embolics were significantly higher in TFA while Onyx was higher in TRA (P<0.001). Following PSM, 150 matched pairs were generated. Particles were more utilized in the TFA group (53% vs 29.7%) and Onyx was more utilized in the TRA group (56.1% vs 31.5%) (P=0.001). Procedural duration was longer in the TRA group (median 68.5 min (IQR 43.1-95) vs 59 (42-84); P=0.038), and radiographic success was higher in the TFA group (87.3% vs 77.4%; P=0.036). No differences were noted in surgical rescue (8.4% vs 10.1%, P=0.35) or technical failures (2.4% vs 2%; P=0.67) between TFA and TRA. Sensitivity analysis in the standalone MMAE retained all associations but differences in procedural duration.
CONCLUSIONS: In this study, TRA offered comparable outcomes to TFA in MMAE for cSDH in terms of access related and overall complications, technical feasibility, and functional outcomes. Procedural duration was slightly longer in the TRA group, and radiographic success was higher in the TFA group, with no differences in surgical rescue rates.
METHODS: Consecutive patients undergoing MMAE for cSDH at 14 North American centers (2018-23) were included. TRA and TFA groups were compared using propensity score matching (PSM) controlling for: age, sex, concurrent surgery, previous surgery, hematoma thickness and side, midline shift, and pretreatment antithrombotics. The primary outcome was access site and overall complications, and procedure duration; secondary endpoints were surgical rescue, radiographic improvement, and technical success and length of stay.
RESULTS: 872 patients (median age 73 years, 72.9% men) underwent 1070 MMAE procedures (54% TFA vs 46% TRA). Access site hematoma occurred in three TFA cases (0.5%; none required operative intervention) versus 0% in TRA (P=0.23), and radial-to-femoral conversion occurred in 1% of TRA cases. TRA was more used in right sided cSDH (58.4% vs 44.8%; P<0.001). Particle embolics were significantly higher in TFA while Onyx was higher in TRA (P<0.001). Following PSM, 150 matched pairs were generated. Particles were more utilized in the TFA group (53% vs 29.7%) and Onyx was more utilized in the TRA group (56.1% vs 31.5%) (P=0.001). Procedural duration was longer in the TRA group (median 68.5 min (IQR 43.1-95) vs 59 (42-84); P=0.038), and radiographic success was higher in the TFA group (87.3% vs 77.4%; P=0.036). No differences were noted in surgical rescue (8.4% vs 10.1%, P=0.35) or technical failures (2.4% vs 2%; P=0.67) between TFA and TRA. Sensitivity analysis in the standalone MMAE retained all associations but differences in procedural duration.
CONCLUSIONS: In this study, TRA offered comparable outcomes to TFA in MMAE for cSDH in terms of access related and overall complications, technical feasibility, and functional outcomes. Procedural duration was slightly longer in the TRA group, and radiographic success was higher in the TFA group, with no differences in surgical rescue rates.
摘要：
背景：随着经桡骨通路（TRA）越来越多地用于神经血管内手术，我们比较了TRA和经股动脉（TFA）在脑膜中动脉栓塞（MMAE）治疗慢性硬膜下血肿（cSDH）。
方法：纳入了在14个北美中心（2018-23）接受MMAE治疗cSDH的连续患者。TRA和TFA组使用倾向评分匹配（PSM）进行比较，控制：年龄，性别,同时手术，以前的手术，血肿厚度和侧面，中线移位,和预处理抗血栓药。主要结果是进入部位和总体并发症，和手术持续时间；次要终点是手术抢救，射线照相改进，以及技术上的成功和停留时间。
结果：872例患者（中位年龄73岁，72.9%的男性)接受了1070次MMAE手术(54%TFAvs46%TRA)。3例TFA病例（0.5％；无手术干预）与TRA中的0％（P=0.23）发生了进入部位血肿，1%的TRA病例发生桡骨向股骨转换。TRA在右侧cSDH中更多使用(58.4%vs44.8%;P<0.001)。TFA中的颗粒栓塞明显较高，而TRA中的Onyx较高（P<0.001）。在PSM之后,产生150个匹配的对。在TFA组中更多地利用了颗粒（53％vs29.7％），在TRA组中更多地利用了Onyx（56.1％vs31.5％）（P=0.001）。TRA组的手术持续时间更长（中位数为68.5分钟（IQR43.1-95）vs59（42-84）；P=0.038），TFA组的X线摄影成功率更高(87.3%vs77.4%;P=0.036)。在手术抢救方面没有发现差异(8.4%vs10.1%，P=0.35）或TFA和TRA之间的技术故障（2.4％vs2％；P=0.67）。独立MMAE的敏感性分析保留了所有关联，但手术持续时间存在差异。
结论：在这项研究中，就获取相关并发症和总体并发症而言，TRA在cSDH的MMAE中提供了与TFA相当的结果，技术可行性,和功能结果。TRA组的手术持续时间稍长，TFA组的射线照相成功率更高，手术抢救率没有差异。
方法：纳入了在14个北美中心（2018-23）接受MMAE治疗cSDH的连续患者。TRA和TFA组使用倾向评分匹配（PSM）进行比较，控制：年龄，性别,同时手术，以前的手术，血肿厚度和侧面，中线移位,和预处理抗血栓药。主要结果是进入部位和总体并发症，和手术持续时间；次要终点是手术抢救，射线照相改进，以及技术上的成功和停留时间。
结果：872例患者（中位年龄73岁，72.9%的男性)接受了1070次MMAE手术(54%TFAvs46%TRA)。3例TFA病例（0.5％；无手术干预）与TRA中的0％（P=0.23）发生了进入部位血肿，1%的TRA病例发生桡骨向股骨转换。TRA在右侧cSDH中更多使用(58.4%vs44.8%;P<0.001)。TFA中的颗粒栓塞明显较高，而TRA中的Onyx较高（P<0.001）。在PSM之后,产生150个匹配的对。在TFA组中更多地利用了颗粒（53％vs29.7％），在TRA组中更多地利用了Onyx（56.1％vs31.5％）（P=0.001）。TRA组的手术持续时间更长（中位数为68.5分钟（IQR43.1-95）vs59（42-84）；P=0.038），TFA组的X线摄影成功率更高(87.3%vs77.4%;P=0.036)。在手术抢救方面没有发现差异(8.4%vs10.1%，P=0.35）或TFA和TRA之间的技术故障（2.4％vs2％；P=0.67）。独立MMAE的敏感性分析保留了所有关联，但手术持续时间存在差异。
结论：在这项研究中，就获取相关并发症和总体并发症而言，TRA在cSDH的MMAE中提供了与TFA相当的结果，技术可行性,和功能结果。TRA组的手术持续时间稍长，TFA组的射线照相成功率更高，手术抢救率没有差异。
