椎动脉起始部狭窄经桡动脉入路与经股动脉入路行介入治疗疗效分析

孙辉; 殷亮; 时鹏; 王春; 刘扬; 叶静静

doi:10.13898/j.cnki.issn.2097-5252.2025.09.005

椎动脉起始部狭窄经桡动脉入路与经股动脉入路行介入治疗疗效分析

Comparison of the effects between trans radial approach and trans femoral approach in the interventional treatment of vertebral artery ostium stenosis

摘要

摘要: 目的：对比分析椎动脉起始部狭窄(VAOS)经桡动脉入路(TRA)与经股动脉入路(TFA)介入治疗的安全性及有效性。方法：回顾性纳入2023年1月至2024年3月行VAOS支架植入术的55例病人，按入路方式分为TRA组(27例)和TFA组(28例)。比较2组病人基线特征、手术参数(目标血管狭窄率、穿刺时间、手术时长、残余狭窄率)、术后恢复指标(住院时间、穿刺点并发症、90 d预后评分)。结果：2组病人术前资料包括年龄、性别、体质量指数(BMI)、相关危险因素(高血压、糖尿病、吸烟饮酒史)、起病形式、术前美国国立卫生研究院卒中量表(National Institute of Health stroke scale，NIHSS)评分、改良Rankin量表(modified rankin scale，mRS)评分差异均无统计学意义(P>0.05)；手术参数方面，2组目标血管狭窄率和穿刺时长差异均无统计学意义(P>0.05)，TRA组手术时长短于TFA组(P<0.01)，术后即刻残余狭窄均<5%；术后恢复方面，TRA组术后住院时间更少(P<0.01)，术后90 d mRS和NIHSS评分组间差异无统计学意义(P>0.05)；并发症方面，TRA组总并发症发生率与TFA组差异无统计学意义(P>0.05)，其中TFA组假性动脉瘤和血管迷走反射各1例，TRA组未发生。结论：TRA与TFA治疗VAOS的有效性相当，但TRA具有手术时间短、术后恢复快、并发症少等优势，可作为优选入路。

Abstract: Objective: To compare and analyze the safety and efficacy of interventional treatment via the trans radial approach(TRA) and trans femoral approach(TFA) for vertebral artery ostium stenosis(VAOS). Methods: A total of 55 patients treated with VAOS stent implantation from January 2023 to March 2024 were retrospectively analyzed,and divided into the TRA group(27 cases) and TFA group(28 cases) according to the approach.The baseline characteristics,surgical parameters(target vascular stenosis rate,puncture time,operation duration and residual stenosis rate),and postoperative recovery indicators(hospital stay,puncture site complications and 90-day prognosis score) between two groups were compared. Results: There was no statistical significance in the preoperative dataincluding the age,gender,BMI,related risk factors(hypertension,diabetes,smoking and drinking history),onset form,preoperative National Institutes of Health stroke scale(NIHSS) scores and modified Rankin scale(mRS) scores between two groups(P>0.05).In terms of surgical parameters,there was no statistical significance in the target vessel stenosis rates and puncture times between two groups(P>0.05).However,the operation duration in the TRA group was shorter than that in TFA group(P<0.01),and the immediate postoperative residual stenosis in two groups were less than 5%.Regarding postoperative recovery,the length of hospital stay in the TRA group was shorter compared with that of TFA group(P<0.01),and there was no statistical significance in the 90-day mRS and NIHSS scores between two groups(P>0.05).As for complications,there was no statistical significance in the overall complication rate between two groups(P>0.05).There was 1 case of pseudoaneurysm and 1 case of vasovagal reflex in the TFA group,while no such cases occurred in the TRA group. Conclusions: The effectiveness of TRA in treating VAOS is comparable to that of TFA,but TRA has advantages such as shorter operation time,faster postoperative recovery and fewer complications,and can be used as the preferred approach.

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