Comparison of effectiveness of stenting for vertebral artery ostium severe stenosis via transradial access and transfemoral access / 中华神经医学杂志

ABSTRACT

Objective:To analyze the differences of effectiveness of stenting for vertebral artery ostium severe stenosis via transradial access and transfemoral access. Methods:Sixty-three patients with vertebral artery ostium severe stenosis confirmed by cerebral angiography in our hospital from December 2017 to March 2022 were enrolled. Stent implantation via transradial access was performed in 30 patients (radial artery group) and stent implantation via transfemoral access was performed in 33 patients (femoral artery group). The radial artery group was divided into left and right subgroups according to the lesions of vertebral arteries; and according to the anatomical classification of vertebral arteries, radial artery group was divided into two subgroups: anatomical type I and anatomical type II. The baseline data and surgery-related data (success rate of stent implantation, time from sheath insertion to stent implantation, surgical time, exposure time, and incidence of surgical complications) of patients in the radial artery group and femoral artery group were compared and analyzed. The surgical data of patients in the subgroups of radial artery group were compared and analyzed. Results:There was no significant difference in the success rate of stent implantation or incidence of primary endpoint events 3 d after surgery between the radial artery group and femoral artery group ( P>0.05). The time from sheath insertion to stent implantation, surgical time, and exposure time in the radial artery group were statistically shorter than those in the femoral artery group ( P<0.05). The radial artery group had significantly lower incidence of complications (9.01% vs. 30.0%) and incidence of hematoma (3.03% vs. 20.05) at the puncture sites than the femoral artery group ( P<0.05). Time from sheath insertion to stent implantation, surgical time, and exposure time in the anatomical type I patients of radial artery group were significantly longer than those in the anatomical type II patients ( P<0.05); those in patients with left lesions of radial artery group were significantly shorter than those in patients with right lesions ( P<0.05). Conclusion:As compared with that via transfemoral access, the stenting via transradial access has almost the same success rate, without significant difference in incidence of perioperative serious complications, and stenting via transradial access has shorter surgical time, lower surgical difficulty, and lower incidence of complications; patients with anatomical type II or left lesions have better efficacy than those with anatomical type I or right lesions.