Abstract：
OBJECTIVE: This study aimed to evaluate the safety and effectiveness of transbrachial access (TBA) and transradial access (TRA) compared to transfemoral access (TFA) for large-bore neuro stenting (≥7 F).
METHODS: From January 2019 to January 2024, 4752 patients received large-bore neuro stenting in our center. The primary outcomes were procedural metrics. Safety outcomes were significant access site complications, including substantial hematoma, pseudoaneurysm, artery occlusion, and complications requiring treatment (medicine, intervention, or surgery). After propensity score matching with a ratio of 1:1:2 (TBA: TRA: TFA), adjusting for age, gender, aortic arch type, and neuro stenting as covariates, outcomes were compared between groups.
RESULTS: 46 TBA, 46 TRA and 92 TFA patients were enrolled. The mean age was 67.8 ± 11.2 years, comprising 127 (69.0%) carotid artery stenting and 57 (31.0%) vertebral artery stenting. The rates of technical success (TBA: 100%, TRA: 95.7%, TFA: 100%) and significant access site complications (TBA: 4.3%, TRA: 6.5%, TFA: 1.1%) were comparable between the groups (P > 0.05). Compared to TFA, the TRA cohort exhibited significant delays in angiosuite arrival to puncture time (14 vs. 8 min, P = 0.039), puncture to angiography completion time (19 vs. 11 min, P = 0.027), and procedural duration (42 vs. 29 min, P = 0.031). There were no substantial differences in procedural time metrics between TBA (10, 14, and 31 min, respectively) and TFA.
CONCLUSIONS: TBA and TRA as the primary access for large-bore neuro stenting are safe and effective. Procedural delays in TRA may favor TBA as the first-line alternative access to TFA.
METHODS: From January 2019 to January 2024, 4752 patients received large-bore neuro stenting in our center. The primary outcomes were procedural metrics. Safety outcomes were significant access site complications, including substantial hematoma, pseudoaneurysm, artery occlusion, and complications requiring treatment (medicine, intervention, or surgery). After propensity score matching with a ratio of 1:1:2 (TBA: TRA: TFA), adjusting for age, gender, aortic arch type, and neuro stenting as covariates, outcomes were compared between groups.
RESULTS: 46 TBA, 46 TRA and 92 TFA patients were enrolled. The mean age was 67.8 ± 11.2 years, comprising 127 (69.0%) carotid artery stenting and 57 (31.0%) vertebral artery stenting. The rates of technical success (TBA: 100%, TRA: 95.7%, TFA: 100%) and significant access site complications (TBA: 4.3%, TRA: 6.5%, TFA: 1.1%) were comparable between the groups (P > 0.05). Compared to TFA, the TRA cohort exhibited significant delays in angiosuite arrival to puncture time (14 vs. 8 min, P = 0.039), puncture to angiography completion time (19 vs. 11 min, P = 0.027), and procedural duration (42 vs. 29 min, P = 0.031). There were no substantial differences in procedural time metrics between TBA (10, 14, and 31 min, respectively) and TFA.
CONCLUSIONS: TBA and TRA as the primary access for large-bore neuro stenting are safe and effective. Procedural delays in TRA may favor TBA as the first-line alternative access to TFA.
摘要：
目的：本研究旨在评估经肱动脉入路(TBA)和经桡动脉入路(TRA)与经股动脉入路(TFA)治疗大孔神经支架(≥7F)的安全性和有效性。
方法：从2019年1月至2024年1月，4752例患者在我们中心接受了大口径神经支架置入术。主要结果是程序指标。安全性结果是显著的进入部位并发症，包括大量的血肿,假性动脉瘤,动脉闭塞,和需要治疗的并发症(药物，干预，或手术）。在倾向得分与1：1：2（TBA：TRA：TFA）的比例匹配后，调整年龄，性别,主动脉弓型,神经支架作为协变量，比较两组间的结局.
结果：46TBA，纳入46例TRA和92例TFA患者。平均年龄为67.8±11.2岁,包括127（69.0％）颈动脉支架置入术和57（31.0％）椎动脉支架置入术。技术成功率(TBA:100%，TRA:95.7%,TFA：100%）和显著的进入部位并发症（TBA：4.3%，TRA:6.5%,TFA:1.1%)组间比较(P>0.05)。与TFA相比，TRA队列显示血管套件到达穿刺时间显著延迟(14vs.8分钟,P=0.039),穿刺至血管造影完成时间(19vs.11分钟,P=0.027),和程序持续时间(42与29分钟,P=0.031)。TBA之间的手术时间指标没有实质性差异(10、14和31分钟，分别)和TFA。
结论：TBA和TRA作为大口径神经支架置入术的主要通路是安全有效的。TRA的程序性延迟可能会使TBA成为对TFA的一线替代访问。
方法：从2019年1月至2024年1月，4752例患者在我们中心接受了大口径神经支架置入术。主要结果是程序指标。安全性结果是显著的进入部位并发症，包括大量的血肿,假性动脉瘤,动脉闭塞,和需要治疗的并发症(药物，干预，或手术）。在倾向得分与1：1：2（TBA：TRA：TFA）的比例匹配后，调整年龄，性别,主动脉弓型,神经支架作为协变量，比较两组间的结局.
结果：46TBA，纳入46例TRA和92例TFA患者。平均年龄为67.8±11.2岁,包括127（69.0％）颈动脉支架置入术和57（31.0％）椎动脉支架置入术。技术成功率(TBA:100%，TRA:95.7%,TFA：100%）和显著的进入部位并发症（TBA：4.3%，TRA:6.5%,TFA:1.1%)组间比较(P>0.05)。与TFA相比，TRA队列显示血管套件到达穿刺时间显著延迟(14vs.8分钟,P=0.039),穿刺至血管造影完成时间(19vs.11分钟,P=0.027),和程序持续时间(42与29分钟,P=0.031)。TBA之间的手术时间指标没有实质性差异(10、14和31分钟，分别)和TFA。
结论：TBA和TRA作为大口径神经支架置入术的主要通路是安全有效的。TRA的程序性延迟可能会使TBA成为对TFA的一线替代访问。
