A better avenue for neurosurgery to improve outcomes

PHILADELPHIA – For years, cardiologists have inserted surgical instruments resembling hair in the arteries of the wrist, as an access point for interventions on the heart. For interventions in the brain, however, neurosurgeons usually thread instruments into the arteries of the groin – a transfemoral approach. In the largest cohort study to date, a new study by Jefferson (University of Philadelphia and Thomas Jefferson University) demonstrates that transradial surgery, performed on the wrist, is safe and effective for a wide range of neuroendovascular interventions and allows patients to recover faster by requiring fewer interventions. risk.

"Despite an improvement in safety demonstrated in major cardiology trials, transradial wrist surgeries are far less common," says lead author of the study and neurosurgeon Pascal Jabbour, MD, professor of neurological surgery and chief of the neurovascular and endovascular neurosurgery division. and researcher at the Vickie Institute of Neuroscience & Jack Farber – Jefferson Health. "Neurosurgeons tend to prefer the transfemoral approach that many of us have been trained in. But our research shows that all kinds of neurological procedures can be performed efficiently and even more safely via the wrist. "

The results were published in the journal Stroke July 17th.

Dr. Jabbour and his team, including lead author Omaditya Khanna, retrospectively reviewed the medical records of 223 patients treated with Jefferson transradially. The procedures included diagnostic angiograms, mechanical thrombectomies, MAV / AVV embolizations, winding, stent-badisted winding, WEB device placement, and cerebral aneurysm flow deflection treatments and placement. carotid stent.

A subset of 66 patients undergoing both transfemoral (groin) and transradial (wrist) surgeries was selected to respond to a satisfaction survey to evaluate their preference. The majority of patients, 94%, reported a preference for wrist surgery.

In addition, it is easier to ensure that the blood vessel of the wrist has coagulated. Thus, patients can return home shortly after surgery, instead of lying horizontally for 4 to 6 hours after transfemoral surgery. "Avoid laying flat after certain types of brain surgery in cases of high intracranial pressure, and yet it is the best way to prevent internal bleeding and those of the groin", said Dr. Jabbour. "For these cases, wrist surgery is by far the safest option."

According to Dr. Jabbour, one of the most compelling reasons for changing practice is that it eliminates the risk of rare but potentially dangerous complications of post-surgical bleeding in the groin and retroperitoneal area, which can be difficult to detect. A pioneer in this field, Dr. Jabbour was one of the first neurosurgeons to practice brain surgery by the wrist and continued to teach this technique to others.

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Article number: Omaditya Khanna, Ahmad Sweid, Nikolaos Mouchtouris, Kavya Shivashankar, Vivan Xu, Lohit Velapapudi, Geoffrey P. Stricsek, Abdelhbaden, for neuroendovascular interventions: clinical results and measures of patient satisfaction, " Stroke, DOI: 10.1161 / STROKEAHA.119.025811, 2019.

Media contact: Edyta Zielinska, 215-955-7359, [email protected]

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