Pigtail catheter exchange technique for the Simmons catheter formation in transradial cerebral angiography.

BACKGROUND: The transradial approach (TRA) has become popular for diagnostic cerebral angiography. However, this approach is still used less often because of problematic formation of the Simmons catheter. The purpose of this study was to introduce a pigtail catheter exchange technique for Simmons catheter formation to improve the success rates with a shorter operation time and without increasing complications. METHODS: This retrospective study included consecutive patients eligible for right TRA cerebral angiography at our institution from 2021. To introduce the technique, the cerebral angiogram of formation of the Simmons catheter in the type II aortic arch was constructed. Patient demographic and angiographic data were collected. RESULTS: In total, 295 cerebral angiographies were evaluated. There were 155 (52.5 %), 83 (28.1 %), 39 (13.2 %), and 18 (6.1 %) patients with types I, II, and III aortic arches and bovine arch, respectively. The total fluoroscopy time, operation time and radiation exposure were 6.3 ± 4.4 min, 17.7 ± 8.3 min and 559.2 ± 197.3 mGy, respectively. The Simmons catheter was successfully formed in 294 of 295 patients, with a success rate of 99.6 %, confirming an effective technique for right TRA cerebral angiography. No severe complications were observed in any patient. CONCLUSIONS: Pigtail catheter exchange may be an effective and safe technique for right TRA cerebral angiography. The findings of this report prompted institutions to apply this technique clinically and can serve as a basis for future trials focused on TRA cerebral angiography.

[The impact of early alimentary nutrition on short-term prognosis after acute stroke].

OBJECTIVE: To discuss the short-term effects of early naso-gastric nutrition after acute stroke. METHODS: In a prospective non-randomized controlled design, 146 stroke patients with dysphagia were included. 75 patients in the intervention group received standard naso-gastric nutrition and 71 patients in the control group and received feeding supervised by family members. We observed the nutrition status, infective complications and mortality between the two groups for 21 days. Neurological deficit was evaluated with NIH stroke scale, Barthel index and the modified of Rankin Scale, the latter scale being calculated for 90 days. RESULTS: After 21 days, the nutritional parameters (triceps skin thickness, arm muscle circumference, haemoglobin, serum albumin, and triglycerides) in the intervention group were significantly better than those in the control group. Malnutrition was observed in 27.1% of the intervention group and 48.3% of the control group (P = 0.014). The incidence of infective complications was 33.3% in the intervention group and 52.1% in the control group (P = 0.022). Mortality rate was 6.7% in the intervention group and 18.1% in the control group (P = 0.032). The score of NIH stroke scale on the 21st day in the intervention group was also significantly better than that in the control group (P = 0.008). However, the Barthel index on the 21st day and the score of the modified Rankin Scale on the 90th day of follow-up were not statistically different between the two groups. CONCLUSIONS: It is suggested that standardized naso-gastric nutrition is helpful for improving short-term neurological function following acute stroke. However, improvement of Barthel index and the score of the modified Rankin Scale needs more therapeutic measures besides nutritional support.