替罗非班在支架辅助弹簧圈栓塞颅内动脉瘤中的疗效分析

Effect analysis of tirofiban in stent-assisted coil embolization of intracranial aneurysms

目的探讨替罗非班抗血小板治疗在支架辅助栓塞颅内动脉瘤中的安全性和有效性。方法回顾性分析2015年1月至2019年6月淄博市第一医院神经外科65例行颅内动脉瘤支架辅助弹簧圈栓塞术患者的临床资料,将术前口服阿司匹林肠溶片、波立维者作为双抗组,将术中直接应用替罗非班者作为替罗非班组;按照术中支架内有无急性血栓形成分为急性血栓组和无急性血栓组;将直接应用替罗非班的病例按照术前动脉瘤是否破裂分为破裂组和未破裂组,分别比较双抗组与替罗非班组、急性血栓组与无急性血栓组、破裂组和未破裂组人口学资料、动脉瘤资料、手术中出血和缺血的发生率。结果双抗组中术中急性血栓形成2例,术中动脉瘤出血1例;替罗非班组术中急性血栓形成6例,术中动脉瘤出血2例,两组术中动脉瘤出血(2.9%vs.6.7%)及术中急性血栓形成(5.7%vs.20.0%)比较差异无统计学意义。急性血栓组与无急性血栓组动脉瘤位置、动脉瘤大小、瘤颈宽度、Hunt-Hess分级、是否双支架及抗血小板方案比较差异均无统计学意义。破裂组与未破裂组中术中血栓发生率(23.5%vs.15.4%)比较差异无统计学意义。结论单纯应用替罗非班抗血小板治疗在支架辅助栓塞颅内动脉瘤手术治疗中安全有效。

Objective To introduce the safety and efficacy of tirofiban antiplatelet therapy in stent-assisted coil embolization of intracranial aneurysms.Methods 65 patients with intracranial aneurysm treated with stent-assisted coil embolization between January 2015 and June 2019 from the Department of Neurosurgery of Zibo First Hospital were enrolled retrospectively.Patients who took aspirin and plavix before surgery were selected as the double antibody group,and those who took tirofiban directly during the operation were selected as the tirofiban group;according to the presence or absence of acute thrombosis in the stent,the patients were divided into the acute thrombosis group and the non-acute thrombosis group;the patients directly treated with tirofiban were divided into the ruptured group and the unruptured group according to whether the aneurysm ruptured before surgery.Demographic data,aneurysm data,incidence of surgical bleeding and ischemia were compared double antibody group and tirofiban group,acute thrombosis group and non-acute thrombosis group,ruptured group and unruptured group,respectively.Results There were 2 cases of intraoperative acute thrombosis and 1 case of intraoperative aneurysm rupture and rebleeding in the Dual antiplatelet group,whereas there was 6 cases of acute thrombosis and 2 cases of intraoperative aneurysm rupture hemorrhage in tirofiban group.There was no statistical difference between the two groups in the rupture hemorrhage of aneurysm(2.9%vs.6.7%)and intraoperative acute thrombosis(5.7%vs.20%).There were no significant differences in aneurysm location,aneurysm size,neck width,Hunt-Hess grade,double stent and antiplatelet regimen between the acute thrombus group and the non-acute thrombus group.There was no significant difference in the incidence of intraoperative thrombosis between the ruptured group and the unruptured group(23.5%vs.15.4%).Conclusion The direct application of tirofiban antiplatelet therapy in stent-assisted coil embolization of intracranial aneurysms has been proven to be both safe and effective.