Transradial Approach as the Primary Vascular Access with a 6-Fr Simmons Guiding Sheath for Anterior Circulation Interventions: A Single -Center Case Series of 130 Consecutive Patients
Transradial Approach as the Primary Vascular Access with a 6-Fr Simmons Guiding Sheath for Anterior Circulation Interventions: A Single -Center Case Series of 130 Consecutive Patients
复制标题
DOI：
10.1016/j.wneu.2020.03.003
复制
发表时间：
2020-06-01
影响因子：
2
通讯作者：
Horiuchi, Tetsuyoshi
中科院分区：
文献类型：
--
作者：
Hanaoka, Yoshiki;Koyama, Jun-ichi;Horiuchi, Tetsuyoshi
在冠状动脉介入治疗中，经桡动脉入路（TRA）越来越多地被用作主要血管通路，因为它比经股动脉入路具有许多优点。然而，在神经介入治疗中，传统的TRA与直线形引导系统被用作替代血管通路，因为经桡动脉颈动脉插管对于与右锁骨下动脉成陡峭角度的右颈总动脉（CCA）病变或非牛源性的左CCA病变在技术上具有挑战性。本研究的目的是评估TRA作为主要血管通路的可行性和安全性，采用预成形Simmons导引鞘进行前循环interventions.MethodsBetween 2018年6月至2019年9月，130例连续患者（75例颈动脉支架植入术和55例脑动脉瘤弹簧圈栓塞术病例）接受TRA作为主要血管通路。根据术前图像评估选择插管技术，将6 Fr Simmons导引鞘管导入目标CCA。我们回顾性分析了颈动脉插管成功率、手术成功率和围手术期或血管穿刺部位并发症。（69例右侧CCA，6例左侧CCA，牛源性，55例非牛源性左颈总动脉）和随后的手术均成功进行，所有130例患者均无围手术期或血管穿刺部位并发症。用于前循环介入的Fr Simmons导引鞘对于所有目标CCA和主动脉弓类型均非常成功和安全。该方法可用作前循环介入的主要血管通路。
ObjectiveIn coronary intervention, the transradial approach (TRA) is increasingly used as the primary vascular access because of its numerous advantages over the transfemoral approach. However, in neurointerventions, conventional TRA with a straight-shaped guiding system is used as an alternative vascular access because transradial carotid cannulation can be technically challenging for right common carotid artery (CCA) lesions with steep angulation to the right subclavian artery or left CCA lesions with a nonbovine origin. The purpose of the present study was to evaluate the feasibility and safety of TRA as the primary vascular access with a pre-shaped Simmons guiding sheath for anterior circulation interventions.MethodsBetween June 2018 and September 2019, 130 consecutive patients (75 carotid artery stenting and 55 cerebral aneurysm coiling cases) who underwent TRA as the primary vascular access were included in this study. A 6-Fr Simmons guiding sheath was introduced into the target CCA by selecting a cannulation technique based on preprocedural image assessment. We retrospectively analyzed the carotid cannulation success, procedural success, and periprocedural or vascular access site complications.ResultsCarotid cannulation (69 right CCA, 6 left CCA with a bovine origin, and 55 left CCA with a nonbovine origin) and the subsequent procedure were successfully performed for all 130 patients without periprocedural or vascular access site complications.ConclusionsTRA with a 6-Fr Simmons guiding sheath for anterior circulation interventions is highly successful and safe for all target CCAs and aortic arch types. This method can be utilized as the primary vascular access for anterior circulation interventions.