经桡动脉入路右侧大脑中动脉支架成形术可行性分析

Feasibility Analysis of Right Middle Cerebral Artery Stenting via Transradial Approach

关键词:  股动脉入路  桡动脉入路  脑梗死  大脑中动脉  狭窄

Key words:  transfemoral approach  transradial approach  cerebral infarction  middle cerebral artery  stenosis

摘要:

本研究探讨经桡动脉入路(Transradial Approach,TRA)右侧大脑中动脉支架成形术的可行性、安全性和手术技巧。实验按照随机数表法将符合大脑中动脉支架成形术纳入标准的急性脑梗死患者分为观察组和对照组。观察组给予经TRA右侧大脑中动脉支架成形术，对照组给予经股动脉入路(Transfemoral Approach,TFA)右侧大脑中动脉支架成形术，对比分析2组患者导引导管到位情况、支架置入成功率、路径差异相关并发症、手术操作时间、射线投射时间、术后住院时间和手术费用。结果显示，观察组导引导管到位成功率为93.10%(27/29)，对照组导引导管到位成功率100%，2组患者支架置入成功率均较高，路径差异相关并发症较低，手术操作时间、射线投射时间和手术费用相似，差异无统计学意义。基于主动脉弓型的亚组分析，观察组Ⅲ型主动脉弓患者手术操作时间(min)、射线投射时间(min)均短于对照组(73.8±15.3 vs 89.5±14.4；22.1±5.5 vs 28.4±8.3)，差异有统计学意义(t=0.192，P=0.000；t=0.117，P=0.000)。与对照组相比，观察组患者术后住院天数明显减少(2.8±0.6 vs 4.2±0.8)，差异有统计学意义(t=0.230，P=0.002)。因此，经TRA右侧大脑中动脉支架成形术成功率高，对于Ⅲ型主动脉弓患者采用该项方案能减少手术时间和射线投射时间，且术后住院天数少，可行性好。

Abstract:

This study was to investigate the feasibility,safety and surgical techniques of Transradial Approach (TRA) for right middle cerebral artery stenting.According to the random number table method,patients with acute cerebral infarction who met the inclusion criteria of middle cerebral artery stenting were divided into observation group and control group.The observation group was given right middle cerebral artery stenting via TRA,and the control group was given right middle cerebral artery stenting via Transfemoral Approach (TFA).The guiding catheter placement,success rate of stent implantation,path difference related complications,operation time,ray projection time,postoperative hospitalization time and operation cost were compared between the two groups.The results showed that the success rate of guiding catheter in the observation group was 93.10% (27/29),and the success rate of guiding catheter in the control group was 100%.The success rate of stent implantation in the two groups was high,and the complications related to path difference were low.The operation time,ray projection time and operation cost were similar,and the difference was not statistically significant.Based on the subgroup analysis of aortic arch type,the operation time (min) and ray projection time (min) of patients with type Ⅲ aortic arch in the observation group were shorter than those in the control group (73.8±15.3 vs 89.5±14.4;22.1±5.5 vs 28.4±8.3),the difference was statistically significant (t=0.192,P=0.000;t=0.117,P=0.000).Compared with the control group,the postoperative hospital stay in the observation group was significantly reduced (2.8±0.6 vs 4.2±0.8),and the difference was statistically significant (t=0.230,P=0.002).Therefore,the success rate of TRA right middle cerebral artery stenting is high.For patients with type Ⅲ aortic arch,this scheme can reduce the operation time and ray projection time,and the postoperative hospital stay is less and the feasibility is good.