支架结合弹簧圈治疗急性期破裂颅内动脉瘤前沿展望

Frontiers and prospects in stent-assisted coiling in acutely ruptured intracranial aneurysms

支架结合弹簧圈栓塞已经越来越多的被用于颅内宽颈、巨大、梭形动脉瘤的介入治疗,并成为颅内动脉瘤血管内治疗的重要手段。但对于急性期破裂颅内动脉瘤而言,支架置入会协同引发血小板聚集,增加颅内缺血事件发生率,因此在围术期应该使用双联抗血小板治疗。然而,抗血小板药物的使用会增加动脉瘤再出血风险,并增加部分患者后续行脑室外引流、颅内血肿清除等外科手术的难度和风险。因此,目前破裂颅内动脉瘤急性期运用支架结合弹簧圈治疗的可行性和安全性仍然存在较大争议。文章对目前国内、外支架结合弹簧圈治疗急性期破裂颅内动脉瘤的研究现状和进展做系统介绍。

Stent-assisted coiling has been widely used in endovascular treatment of wide-necked,giant and fusiform intracranial aneurysm,and has become an important technique for endovascular treatment of intracranial aneurysms.However,for acutely ruptured intracranial aneurysms,stent implantation will cause platelet aggregation and increase the incidence of ischemic events.Therefore,dual antiplatelet therapy should be used during perioperative period of endovascular treatment.However,the use of antiplatelet drugs may increase the risk of rebleeding and increase the difficulty and risk of subsequent external ventricular drainage and evacuation of intracranial hematoma.Therefore,the feasibility and safety of stent-assisted coiling in acutely ruptured intracranial aneurysms are still in dispute.In this article,we briefly introduce the progress in stent-assisted coiling in acutely ruptured intracranial aneurysms.