經(jīng)橈動脈入路神經(jīng)介入治療的入路并發(fā)癥和處理

背景：由于與經(jīng)股動脈相比，經(jīng)橈動脈入路具有更好的安全性，因此越來越多地用于神經(jīng)介入。因此，需要了解潛在的并發(fā)癥，如橈動脈（RA）痙攣、RA閉塞、假性動脈瘤、外滲、動靜脈瘺和腕部血腫及其處理。

目標(biāo)：

介紹單中心在預(yù)防和管理經(jīng)橈動脈入路神經(jīng)血管內(nèi)介入治療相關(guān)的局部入路并發(fā)癥方面的經(jīng)驗。

方法：

我們對前瞻性維護(hù)的數(shù)據(jù)庫進(jìn)行了回顧性分析，并確定了從2018年4月至2021 2月，使用經(jīng)橈動脈入路進(jìn)行的1524次連續(xù)神經(jīng)血管內(nèi)手術(shù)。

結(jié)果：

1524例手術(shù)中，局部經(jīng)橈動脈并發(fā)癥發(fā)生率為1.7%。主要并發(fā)癥發(fā)生率為1.2%，包括RA外滲（0.3%）、延遲性RA閉塞（0.6%）、假性動脈瘤（0.1%）、室間隔綜合征（0.1%）、感染（0.1%）和RA撕脫傷（0.1%），無嚴(yán)重臨床后果。雖然RA閉塞包括在主要并發(fā)癥中，但所有病例均無癥狀，無需任何干預(yù)。輕微并發(fā)癥發(fā)生率為0.5%，包括嚴(yán)重RA痙攣（0.3%）和血腫（0.3%）。

隊列中沒有患者因經(jīng)橈動脈入路相關(guān)并發(fā)癥死亡或永久殘疾。

結(jié)論：

經(jīng)橈動脈神經(jīng)介入治療的局部并發(fā)癥較低，尤其是在采取適當(dāng)?shù)念A(yù)防措施時。適當(dāng)?shù)牟l(fā)癥管理可以防止手術(shù)失敗，發(fā)病率低，即使發(fā)生并發(fā)癥，也能證明經(jīng)橈動脈入路的整體安全性。

Access Site Complications and Management of the Transradial Approach for Neurointerventions.

BACKGROUND: The transradial approach has increasingly been used for neurointerventions because of the improved safety profile compared with transfemoral. However, it is important to be aware of potential complications such as radial artery (RA) spasm, RA occlusion, pseudoaneurysm,extravasation, arteriovenous fistula, and wrist hematoma as well as their management.

OBJECTIVE: 

To present our institution's experience with the prevention and management of local access site complications associated with the transradial approach for neuroendovascular interventions.

METHODS: 

We conducted a retrospective analysis of a prospectively maintained database and identified 1524 consecutive neuroendovascular procedures performed using transradial access from April 2018 to February 2021.

RESULTS: 

Among 1524 procedures, local transradial complications occurred in 1.7%. Major complications occurred at a rate of 1.2% including RA extravasation (0.3%), delayed RA occlusion(0.6%), pseudoaneurysm (0.1%), compartment syndrome (0.1%), infection (0.1%), and avulsion of the RA in 0.1% (1 of 1524) with no serious clinical consequence. Although RA occlusion is included in major complications, all cases were asymptomatic and did not require any intervention. Minor complications occurred at a rate of 0.5% including severe RA spasm (0.3%) and hematoma (0.3%).

No patient in the cohort died or suffered from permanent disability from a complication related to the transradial approach.

CONCLUSION: 

Transradial access for neurointervention has a low rate of local

complications, particularly when taking appropriate prevention measures. Appropriate management of complications can prevent procedural failure and has low morbidity rates demonstrating the overall safety profile of transradial access even when complications occur.

Neurosurgery 2022 May 11;