经桡动脉与经股动脉脑血管造影诊断方法：关于实用性和成本效益的全面系统回顾和荟萃分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2024-11-09 DOI:10.1016/j.clineuro.2024.108637

Ali Mortezaei , Bardia Hajikarimloo , Mohammad Mirahmadi Eraghi , Sogand Sheikholeslami , Omar Sameer , Ramin Shahidi , Farid Qoorchi Moheb Seraj , Adam A. Dmytriw , Redi Rahmani , Sami Al Kasab

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引用次数: 0

摘要

背景：在经股动脉入路（TFA）和经桡动脉入路（TRA）中选择最合适的方法进行脑血管造影诊断是一个争论不休的话题：比较 TFA 和 TRA 在诊断性脑血管造影中的安全性和有效性：我们在四个数据库中进行了系统检索，以找到相关的临床研究。二元结果通过几率比（OR）和 95 % 置信区间（CI）进行分析和报告，连续结果通过标准化平均差（SMD）和 95 % 置信区间（CI）进行分析和报告：我们纳入了 24 项研究中的 12,693 名患者，这些研究评估了 TRA 与 TFA 在诊断性脑血管造影中的对比。TRA与TFA在总费用（SMD = -0.78，P = 0.51）和鞘费用（SMD = -3.31，P = 0.6）、弥散加权磁共振成像上的高密度灶（OR = 7.15，P = 0.22）、透视时间（SMD = 0.022，P = 0.83）、手术时间（SMD = -0.42，P = 0.14）、辐射暴露（SMD = -0.06，P = 0.81）和对比剂总使用量（SMD = -0.26，P = 0.24）。TRA 的成功率（OR = 0.54，P = 0.0065）和总并发症（OR = 0.5，P = 0.02）显著较低。亚组分析显示，资深神经介入医生和资深神经介入医生在总并发症（P=0.09）、成功率（P=0.62）和透视时间（P=0.35）方面无明显差异：结论：在诊断性脑血管造影术中，TRA的并发症低于TFA，但MRI检测到的弥散加权微栓子发生率较高，因此需要谨慎选择患者和制定手术计划。

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Trans-radial vs. trans-femoral approaches in diagnostic cerebral angiography: A comprehensive systematic review and meta-analysis of practicality and cost-effectiveness

Background

Selecting most appropriate approach between the transfemoral access (TFA) and transradial access (TRA) for diagnostic cerebral angiography is a subject of debate.

Objective

To compare the safety and efficacy of TFA and TRA for diagnostic cerebral angiography.

Methods

We performed a systematic search through four databases to find relevant clinical studies. Binary outcomes were analyzed and reported through the odds ratio (OR) and 95 % confidence interval (CI), while continuous outcomes were analyzed and reported through the standardized mean difference (SMD) and 95 % CI.

Results

We included 12,693 patients from 24 studies that evaluated the TRA vs TFA in diagnostic cerebral angiography. There was no significant difference between TRA and TFA in total (SMD = −0.78, P = 0.51) and sheath (SMD = −3.31, P = 0.6) costs, the hyperintense foci on diffusion-weighted MRI (OR = 7.15, P = 0.22), fluoroscopy time (SMD = 0.022, P = 0.83), procedure time (SMD = −0.42, P = 0.14), radiation exposure (SMD = −0.06, P = 0.81), and total contrast utilization (SMD = −0.26, P = 0.24). The success rate (OR = 0.54, P = 0.0065) and total complication (OR = 0.5, P = 0.02) were significantly lower in TRA. Subgroup analysis showed no significant difference between senior and fellow neurointerventionalists in total complications (P=0.09), success rate (P=0.62), and fluoroscopy time (P=0.35).

Conclusions

TRA was associated with lower complications than TFA for diagnostic cerebral angiography, but the higher incidence of MRI-detected diffusion-weighted microemboli necessitates careful patient selection and procedural planning.

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.