Evaluation Of The Feasibility Of Transradial Neurointervention And Analysis Of Risk Factors For Surgical Failure

PART ⅠTransradial versus Transfemoral Approach for Cerebral Angiography:A Systematic Review and Meta-analysisObjective To evaluate the feasibility,efficiency,and safety of the transradial approach versus the transfemoral approach for cerebral angiography.Methods A comprehensive search was conducted in PubMed,Web of Science,Embase and The Cochrane Library to identify the relevant available articles.The success rate and complications of surgery were analyzed.RevMan software was used to analyze the data,Both the odds ratio(OR),95%confidence interval(CI)and P value were reported.Results Eight cohort studies were included,A total of 6,259 procedures were performed.2733 procedures(43.7%)were performed by transradial approach and 3526 procedures(56.3%)were performed by transfemoral approach.The risk of failure rate in transradial approach group was 1.85 times higher than that in transfemoral approach group,and the combined OR(95%CI)was 1.85(1.11,3.07),P=0.02.The risk of procedure complications incidence was 0.40 times lower in the transradial approach group than in the transfemoral approach group,and the combined OR(95%CI)was 0.40(0.21,0.74),P=0.004.Conclusion In patients underwent cerebral angiography,the present meta-analysis demonstrated that transradial approach has fewer procedure complications than traditional transfemoral approach,but procedure failure rate is higher in the transradial approach group.PART Ⅱ Causes of Failure and Complication Occurrence of Transradial Approach for Neurointerventional procedureObjective This retrospective analysis was aimed to determine the risk factors of procedure failure in patients underwent neurointerventional procedure using transradial approach,and to analyze the causes of procedure failure and complications.Methods We retrospectively analysis our database for all patient who underwent neurointerventional procedure using transradial approach in the Naval Medical University Changhai Hospital from August 2021 to December 2021.All the patients’ age,sex,weight,height,smoking history,hypertension history,smoking history,coronary heart disease history,diabetes history,renal insufficiency,dyslipidemia,peripheral vascular disease history,preoperative antiplatelet drugs,complications,procedure failure,and,if any,reasons for procedure failure were prospectively collected.SPSS version 24.0 statistical software was used for data analysis.Modified Student t test was used for comparison of continuous data,chi-square test was used for comparison of dichotomous data.A probability value of<0.05 was considered statistically significant.Results A total of 226 patients underwent Neurointerventional procedure in the Naval Medical University Changhai Hospital.Mean age was 55.81±13.10 years,average height was 173.75± 6.86 centimeter and 46.5%were female.Transradial approach neurointerventional procedural failure in 20(8.8%)patients through radial artery approach.Single-factor analysis found patient in the transradial approach failure group were more likely to be shorter(169.09±8.03 vs 173.75±6.86,P=0.001)compared with transradial approach success group.The main reason of transradial approach neurointerventional procedural failure is unsuccessful radial artery puncture in 12(60%).The most common complication incidence was forearm hematoma in 5 cases(2.43%).Conclusion Short stature is the risk factor for transradial neurointerventional procedural failure,radial artery unsuccessful puncture is the most important cause of procedure failure,and hematoma of the forearm is the most common complication.Appropriate patient selection and careful risk assessment are needed to maximize benefits offered by transradial neurointerventional procedure.