左侧远端桡动脉/桡动脉入路在神经介入诊疗中的临床应用  

Clinical application of left distal transradial artery/transradial artery access in neurointerventional diagnosis and treatment

作　　者：吴剑 蔡然泽 李秋平 齐飚 WU Jian;CAI Ranze;LI Qiuping;QI Biao(Department of Neurosurgery,Xiamen Branch,Affiliated Zhongshan Hospital of Fudan University,Xiamen,Fujian Province 361000,China)

机构地区：[1]复旦大学附属中山医院厦门医院神经外科,福建厦门361000 [2]复旦大学附属中山医院神经外科,福建厦门361000

出　　处：《介入放射学杂志》2024年第12期1288-1292,共5页Journal of Interventional Radiology

基　　金：2023年福建省自然科学基金面上项目(2023JO11697);2024年厦门市医疗卫生指导性项目(3502Z20244ZD1113);2021年厦门市医疗卫生指导性项目(3502Z20214ZD1083);2018年复旦中山厦门医院孵化课题(2018ZSXMWK09)。

摘　　要：目的观察左侧远端桡动脉(dTRA)/桡动脉(TRA)入路神经介入诊疗的安全性及可行性。方法回顾性分析复旦大学附属中山医院厦门医院2022年1月至2023年12月收治的接受右侧、左侧dTRA/TRA行脑血管造影及神经介入诊疗患者的资料,包括一般信息(年龄、性别、基础疾病等)、临床资料(手术方式、手术入路、X线透视时间、穿刺相关并发症等)。结果纳入经左侧dTRA/TRA行神经介入诊疗患者32例,其中造影11例,介入治疗21例,介入治疗患者均为左侧椎基底动脉疾病。纳入同期经右侧dTRA/TRA行神经介入诊疗患者49例,其中造影19例,血管内治疗30例,介入治疗患者均为右侧椎基底动脉疾病,造影患者均为既往接受治疗后复查造影,且均为前循环系统血管内疾病。所有行介入治疗及造影患者均顺利完成手术且无严重并发症。经左侧dTRA/TRA行介入治疗患者中,4例改TRA完成手术,2例改股动脉(TFA),1例经左侧dTRA因血管通路不稳定改TFA继续完成手术;行造影患者中4例患者改左侧TRA顺利完成造影,共3例患者未能完成选择性右侧锁骨下动脉插管;行介入治疗的患者中有2例术后出现远端桡动脉穿刺点局部淤青,所有造影及介入治疗患者术后复查彩超均未见桡动脉闭塞。经右侧dTRA/TRA行神经介入患者中,4例改右侧TRA完成手术,2例改TFA;行造影患者中4例改右侧TRA,所有患者均顺利完成双侧颈总动脉,双侧锁骨下动脉血管插管,有3例术后出现远端桡动脉穿刺点局部淤青,所有造影及介入治疗患者术后复查彩超均未见桡动脉闭塞。在神经介入诊疗中,经左侧dTRA/TRA和右侧dTRA/TRA对比,穿刺远端桡动脉成功率、术中X线透视时间、对4根主要血管(右侧颈总动脉、左侧颈总动脉、右侧锁骨下动脉、左侧锁骨下动脉)的插管成功率、术后穿刺点并发症的发生率差异均无统计学意义(均P<0.05)。结论左侧远端桡动脉/桡动脉�Objective To investigate the safety and feasibility of performing neurointerventional diagnosis and treatment via left distal transradial access(dTRA)or via left transradial access(TRA).Methods The clinical data of patients,who received selective cerebral angiography or neurointerventional treatment using right/left dTRA/TRA at the Fudan Zhongshan Xiamen Branch Hospital of China between January 2022 and December 2023,were retrospectively analyzed.The clinical data including the basic information(including age,gender,diseases,etc.)and the clinical records(including operation mode,operative approach,X-ray fluoroscopy time,puncture-related complications,etc.)were collected.Results A total of 32 patients,who underwent neurointerventional treatment by using left dTRA/TRA approach(left-side group),were enrolled in this study.Among them 11 patients received selective cerebral angiography and 21 patients(having left-sided vertebrobasilar artery disease)received neurointerventional treatment.Other 49 patients,who underwent neurointerventional treatment by using right dTRA/TRA approach(right-side group)during the same period were also included in this study.Among them 19 patients received selective cerebral angiography and 30 patients(having right-sided vertebrobasilar artery disease)received neurointerventional treatment.Angiography reexamination was performed in the patients who had previously received treatment and all of them suffered from endovascular diseases of the anterior circulation system.All angiography and neurointerventional procedures were successfully accomplished with no occurrence of serious complications.In left-side group,4 patients changed to adopt TRA approach to complete the neurointerventional treatment,2 patients changed to adopt TFA approach to complete the neurointerventional treatment,and one patient changed to adopt TFA approach to complete the procedure due to vascular tortuosity of left dTRA.In patients receiving angiography,4 patients changed to adopt left TRA approach and 3 patients failed

关 键 词：左侧桡动脉入路 左侧远端桡动脉入路 神经介入治疗 脑血管造影 

分 类 号：R651[医药卫生—外科学]