Comparative analysis of the safety and efficacy between trans-radial and trans-femoral artery approach on the implantation of the Pipeline embolization device for the treatment of intracranial aneurysms
Objective To compare the safety and efficacy of transradial approach(TRA)with transfemoral approach(TFA)on the implantation of the Pipeline embolization device(PED)for the treatment of intracranial aneurysms.Methods The study retrospectively collected data on patients who were admitted to the department of Neurointervention,the First Affiliated Hospital of Zhengzhou University between January 2022 and December 2022,and were treated with the PED.The patients were divided into two groups based on their access approach:TRA group(20cases)and TFA group(119cases).Data were recorded and compared,including demographic information(age,gender),related risk factors(hypertension,diabetes,smoking history,stroke history),aneurysmal data(aneurysm shape[cystic,non-cystic],number[single,multiple],location[anterior circulation,posterior circulation and bifurcation],neck of tumor,diameter of parental artery,cyst,whether recurrent aneurysm,whether merging branche),efficacy endpoint(successful PED placement after access establishment and complete coverage of the aneurysm neck),and safety endpoint(intraoperative and postoperative puncture site complications,neurological complications).Puncture site complications included puncture site hematoma,radial artery spasm,radial artery occlusion,etc.Neurological complications included acute stent thrombosis,intraoperative and postoperative stroke,etc.Results There were no significant differences in demographic information,related risk factors and aneurysm-related data between two groups(all P＞0.05).Surgical pathways were successfully established,and PED were successfully implanted in both groups,and no intraoperative pathway conversion occurred.Among the 20patients in TRA group,1 case had postoperative puncture site hematoma,and the incidence rate was 5.0％;postoperative neurological complications occurred in 1 case(5.0％).There were no intraoperative safety endpoints.Among the 119 patients in TFA group,there were 4 cases of postoperative puncture site hematoma,1 case of arteriovenous fistula,and 5 cases of pseudoaneurysm,with the incidence of puncture site complication was 8.4％.There were 8 cases of postoperative neurological complications(6.7％).There were no intraoperative safety endpoints.There was no significant difference in the incidence of postoperative safety endpoint events between two groups(all P＞0.05).Conclusion This preliminary study showed that PED treatment with TRA has comparable efficacy and safety as TFA.
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