目的:经桡动脉通路(TRA)通常用于神经介入手术。这项研究比较了使用TRA和经股动脉(TFA)的技术和临床结果,以WovenEndoBridge(WEB)设备进行颅内动脉瘤栓塞。
方法:这是对全球WEB联盟的二次分析,其中包括与使用WEB设备管理的颅内动脉瘤成年患者相关的多中心数据。这些动脉瘤分为两组:接受TRA或TFA治疗的动脉瘤。比较两组患者和动脉瘤的特征以及技术和临床结果。倾向评分匹配(PSM)用于根据以下基线特征匹配组:年龄,性别,蛛网膜下腔出血,动脉瘤位置,分叉动脉瘤,合并分支的动脉瘤,颈部宽度,纵横比,圆顶宽度,以及自上次随访影像学评估以来的时间。
结果:这项研究包括682个颅内动脉瘤(中位[四分位距]年龄61.3[53.0-68.0]岁),其中561例接受TFA治疗,121例接受TRA治疗。PSM产生65个匹配的对。PSM之后,两组都有相似的特征,血管造影和功能结果,和再治疗率,血栓栓塞和出血并发症,和死亡。TFA与更长的手术时间相关(中位数为96.5分钟vs72.0分钟,p=0.006)和透视时间(28.2分钟vs24.8分钟,与TRA相比,p=0.037)。另一方面,部署问题在接受TRA治疗的患者中更为常见,但没有导致永久性并发症。
结论:TRA具有可比的结果,更短的程序和透视时间,使用WEB设备进行动脉瘤栓塞的TFA。
OBJECTIVE: Transradial access (TRA) is commonly utilized in neurointerventional procedures. This
study compared the technical and clinical outcomes of the use of TRA versus those of transfemoral access (TFA) for intracranial aneurysm embolization with the Woven EndoBridge (WEB) device.
METHODS: This is a secondary analysis of the Worldwide WEB Consortium, which comprises multicenter data related to adult patients with intracranial aneurysms who were managed with the WEB device. These aneurysms were categorized into two groups: those who were treated with TRA or TFA. Patient and aneurysm characteristics and technical and clinical outcomes were compared between groups. Propensity score matching (PSM) was used to match groups according to the following baseline characteristics: age, sex, subarachnoid hemorrhage, aneurysm location, bifurcation aneurysm, aneurysm with incorporated branch, neck width, aspect ratio, dome width, and elapsed time since the last follow-up imaging evaluation.
RESULTS: This
study included 682 intracranial aneurysms (median [interquartile range] age 61.3 [53.0-68.0] years), of which 561 were treated with TFA and 121 with TRA. PSM resulted in 65 matched pairs. After PSM, both groups had similar characteristics, angiographic and functional outcomes, and rates of retreatment, thromboembolic and hemorrhagic complications, and death. TFA was associated with longer procedure length (median 96.5 minutes vs 72.0 minutes, p = 0.006) and fluoroscopy time (28.2 minutes vs 24.8 minutes, p = 0.037) as compared with TRA. On the other hand, deployment issues were more common in those treated with TRA, but none resulted in permanent complications.
CONCLUSIONS: TRA has comparable outcomes, with shorter procedure and fluoroscopy time, to TFA for aneurysm embolization with the WEB device.