Femoral versus radial access for middle meningeal artery embolization for chronic subdural hematomas: multicenter propensity score matched study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Salem Mohamed M, Sioutas Georgios S, Gajjar Avi, Khalife Jane, Kuybu Okkes, Carroll Kate T, Hoang Alex Nguyen, Baig Ammad A, Salih Mira, Baker Cordell, Cortez Gustavo M, Abecassis Zack, Ruiz Rodriguez Juan Francisco, Davies Jason M, Cawley C Michael, Riina Howard, Spiotta Alejandro M, Khalessi Alexander, Howard Brian M, Hanel Ricardo A, Tanweer Omar, Tonetti Daniel, Siddiqui Adnan H, Lang Michael, Levy Elad I, Ogilvy Christopher S, Srinivasan Visish M, Kan Peter, Gross Bradley A, Jankowitz Brian, Levitt Michael R, Thomas Ajith J, Grandhi Ramesh, Burkhardt Jan Karl
Аннотация
METHODS: Consecutive patients undergoing MMAE for cSDH at 14 North American centers (2018-23) were included. TRA and TFA groups were compared using propensity score matching (PSM) controlling for: age, sex, concurrent surgery, previous surgery, hematoma thickness and side, midline shift, and pretreatment antithrombotics. The primary outcome was access site and overall complications, and procedure duration; secondary endpoints were surgical rescue, radiographic improvement, and technical success and length of stay.
RESULTS: 872 patients (median age 73 years, 72.9% men) underwent 1070 MMAE procedures (54% TFA vs 46% TRA). Access site hematoma occurred in three TFA cases (0.5%; none required operative intervention) versus 0% in TRA (P=0.23), and radial-to-femoral conversion occurred in 1% of TRA cases. TRA was more used in right sided cSDH (58.4% vs 44.8%; P<0.001). Particle embolics were significantly higher in TFA while Onyx was higher in TRA (P<0.001). Following PSM, 150 matched pairs were generated. Particles were more utilized in the TFA group (53% vs 29.7%) and Onyx was more utilized in the TRA group (56.1% vs 31.5%) (P=0.001). Procedural duration was longer in the TRA group (median 68.5 min (IQR 43.1-95) vs 59 (42-84); P=0.038), and radiographic success was higher in the TFA group (87.3% vs 77.4%; P=0.036). No differences were noted in surgical rescue (8.4% vs 10.1%, P=0.35) or technical failures (2.4% vs 2%; P=0.67) between TFA and TRA. Sensitivity analysis in the standalone MMAE retained all associations but differences in procedural duration.
CONCLUSIONS: In this study, TRA offered comparable outcomes to TFA in MMAE for cSDH in terms of access related and overall complications, technical feasibility, and functional outcomes. Procedural duration was slightly longer in the TRA group, and radiographic success was higher in the TFA group, with no differences in surgical rescue rates.