颅内动脉瘤支架辅助栓塞术中急性血栓形成的治疗

Treatment of acute thrombosis in stent-assisted embolization of intracranial aneurysms

目的探讨支架辅助栓塞颅内动脉瘤术中支架内血栓形成的治疗方案。方法回顾性分析2012年1月至2015年1月因颅内动脉瘤在西京医院接受支架辅助栓塞治疗共276例,术中支架内血栓形成16例,其中未破裂动脉瘤7例,破裂动脉瘤9例,囊性动脉瘤14例,夹层动脉瘤2例,总结患者临床资料。使用替罗非班溶栓7例,使用支架取栓2例,使用微导管微导丝通过4例,未处理6例。结果溶栓取栓血管再通8例,术后出血1例,血栓栓塞相关症状4例。结论未破裂动脉瘤术中血栓形成使用替罗非班动脉接触性溶栓联合静脉给药是安全有效的。已破裂动脉瘤术中血栓形成后使用替罗非班动脉接触性溶栓联合静脉给药溶栓治疗方法的安全有效性仍需进一步观察,可使用微导管微导丝通过的办法达到血管再通。

Objective The treatment of stent thrombosis in stent-assisted embolization of intracranial aneurysms was studied. Methods Retrospective analysis of 276 patients with intracranial aneurysm in Xijing Hospital from January 2012 to January 2015 were reviewed. Stent thrombosis was performed in 16 cases,including 7 cases of un-ruptured aneurysm and ruptured aneurysm in 9 cases,14 cases of cysticaneurysm,and 2 cases of dissecting aneurysm. The clinical data of all patients were summarized. Thrombolysis was performed in 7 cases with Tirofiban,mechanical embolectomy with stent in 2 cases,and micro-catheter microguide wire in 4 cases. Results Thrombolysis was taken in 8 cases,post-operative intracranial hemorrhage in 1 case,and thrombosis related symptoms occurred in 4 cases. Conclusion It is safe and effective to use Tirofiban in arterial contact thrombolysis combined with intravenous administration for the un-ruptured aneurysms. The safety and effect of Tirofiban for the ruptured aneurysms still need further observation. Micro-catheter microguide wire is suggested for the vascular reperfusion.