目的:尽管机械血栓切除术(MT)主要通过经股动脉(TFA)进行,经桡动脉入路(TRA)是老年患者或血管弯曲患者的潜在替代方法。然而,桡动脉的小直径限制了大口径球囊导管和抽吸导管的使用,使用无护套技术可以克服的限制。因此,我们旨在探索可行性,功效,无鞘TRA-MT作为急性缺血性卒中一线治疗方法的安全性。
方法:此单中心回顾性病例系列包括在2020年9月至2023年6月期间接受TRA-MT作为一线治疗的患者。根据我们的MT协议,对于3型主动脉弓的左前循环病变,TRA不是一线方法。我们根据成功的再通率评估治疗效果,穿刺到再通时间,和修改后的首过效应;基于穿刺至首过时间和转换至TFA率的进入路线有效性;以及基于与手术相关的严重穿刺部位并发症的手术安全性。
结果:无护套8-F引导导管在68%的手术中使用,大口径抽吸导管在70%的手术中使用。98%的患者成功再通,其中54%具有改良的首过效应。中位穿刺至首通和穿刺至再通时间分别为20.5和33分钟,分别。手术相关并发症发生率较低(4%),没有严重的穿刺部位并发症。
结论:无护套TRA-MT能够使用大口径导管和抽吸导管,为目标和令人满意的结果提供迅速的方法,可能是急性缺血性卒中的有效一线治疗方法。
OBJECTIVE: Although mechanical thrombectomy (MT) is primarily performed via transfemoral access (TFA), transradial access (TRA) is a potential alternative in older patients or those with tortuous vessels. However, the small radial artery diameter restricts the use of large-bore balloon guides and aspiration catheters, a limitation that may be overcome using the sheathless technique. Thus, we aimed to explore the feasibility, efficacy, and safety of sheathless TRA-MT as a first-line treatment approach for acute ischemic stroke.
METHODS: This single-center retrospective
case series included patients who underwent TRA-MT as first-line treatment between September 2020 and June 2023. Per our MT protocol, TRA was not the first-line approach in cases of left anterior circulation lesions with a type 3 aortic arch. We evaluated treatment effectiveness based on the successful recanalization rate, puncture-to-recanalization time, and modified first-pass effect; access route effectiveness based on the puncture-to-first-pass time and switch-to-TFA rate; and procedure safety based on procedure-related and severe puncture site complications.
RESULTS: Sheathless 8-F guide catheters were used in 68 % and large-bore aspiration catheters in 70 % of the procedures. Successful recanalization was achieved in 98 % of the patients, with a modified first-pass effect in 54 % of them. The median puncture-to-first-pass and puncture-to-recanalization times were 20.5 and 33 min, respectively. The rate of procedure-related complications was low (4 %), with no severe puncture site complications.
CONCLUSIONS: Sheathless TRA-MT enabled the use of large-bore guide and aspiration catheters, providing a swift approach to the target and satisfactory outcomes, and might be an effective first-line treatment for acute ischemic stroke.