Introduction

The distal transradial approach (dTRA) is progressively gaining more clinical use in the fields of cardiology and other vascular interventions, as it offers a number of advantages compared to conventional radial approach (TRA). These include lower rates of vascular occlusion which permits preservation of the proximal radial artery for future procedures in the event of a distal occlusion.

Aim

To share the experience in the use of dTRA for neurointerventions, showing its advantages, pitfalls as well as sharing our optimized puncture and hemostatic ultrarapid compression protocols to improve the use of this vascular access.

Methods

A retrospective analysis of our experience of diagnostic and interventional procedures performed via dTRA using an optimized protocol for puncture and postpuncture compression of the dTRA was performed.

The rate of complications (hematoma and arterial dissection at puncture site) femoral crossover, and assessment of postprocedural stenosis/occlusion with the ultrarapid compression protocol were also assessed.

Results

From March 2019 to July 2020 a total of 100 distal radial procedures were carried out and 53 diagnostic angiograms (53%) and 47 interventional procedures (47%) were included in the analysis. We achieved a 96% technical success, with a femoral crossover requirement in 3 cases (3%), and one conventional TRA crossover due to puncture failure.

Of the patients 3 presented puncture site hematomas (3%) with no intervention required, 61 patients (61%) underwent the ultrarapid hemostasis protocol in association with a hemostatic pad. Ultrasound follow-up was performed in 20 patients (20%) at 1–2 months with 1 case of occlusion (5%) and 2 of radial stenosis (10%). In all 3 cases proximal radial artery remained patent.

Conclusion

The dTRA is a safe and feasible access route for angiography and neurointerventions. Using vasodilators prepuncture, we attained a variable increase in the vascular diameter facilitating puncture and reducing the risk of occlusion and vascular spasm.

A rapid deflation protocol for postpuncture hemostasis does not significantly increase the hematoma rate.

中文翻译：

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用于神经血管造影和神经干预的远端经桡动脉通路

介绍

远端经桡动脉入路 (dTRA) 在心脏病学和其他血管介入领域逐渐获得更多临床应用，因为与传统的桡动脉入路 (TRA) 相比，它具有许多优势。这些包括较低的血管闭塞率，这允许在远端闭塞的情况下保留近端桡动脉以用于未来的手术。

目标

分享使用 dTRA 进行神经干预的经验，展示其优势和缺陷，并分享我们优化的穿刺和止血超快速压缩方案，以改善这种血管通路的使用。

方法

对我们使用 dTRA 穿刺和穿刺后压缩的优化方案通过 dTRA 执行的诊断和介入程序的经验进行了回顾性分析。

还评估了并发症（穿刺部位的血肿和动脉夹层）股骨交叉的发生率，以及超快速加压方案对术后狭窄/闭塞的评估。

结果

从 2019 年 3 月到 2020 年 7 月，共进行了 100 次远端桡动脉手术，其中 53 次诊断性血管造影（53%）和 47 次介入手术（47%）被纳入分析。我们取得了 96% 的技术成功率，其中 3 例 (3%) 需要股骨交叉，以及由于穿刺失败而导致的 1 例常规 TRA 交叉。

3 名患者出现穿刺部位血肿（3%），无需干预，61 名患者（61%）接受了与止血垫相关的超快速止血方案。在 1-2 个月内对 20 名患者 (20%) 进行了超声随访，其中 1 例闭塞 (5%) 和 2 例桡骨狭窄 (10%)。所有 3 例桡动脉近端均保持通畅。

结论

dTRA 是一种安全可行的血管造影和神经介入通路。使用血管扩张剂预穿刺，我们实现了血管直径的可变增加，从而促进了穿刺并降低了闭塞和血管痉挛的风险。

用于穿刺后止血的快速通缩方案不会显着增加血肿率。