支架辅助栓塞颅内破裂动脉瘤后再出血16例临床分析

Clinical analysis on 16 cases of cerebral rebleeding after stent-assisted embolization of ruptured intracranial aneurysm

目的分析支架辅助栓塞颅内破裂动脉瘤后再出血的病因及其防治措施。方法抽取2011年1月至2017年12月于郑州大学第一附属医院行单支架辅助弹簧圈栓塞颅内破裂动脉瘤手术的患者655例,其中发生围术期手术相关再出血16例,均为单发动脉瘤,男4例,女12例,年龄21~84岁。统计16例患者再出血情况及临床结局,评估改良Rankin(mRS)评分。结果655例患者围术期再出血发生率为2.4%(16/655)。16例中术中动脉瘤再出血9例,其中5例死亡,1例mRS评分4分,3例mRS评分1分。术后再出血7例,5例为动脉瘤再出血,其中4例死亡,1例介入治疗后行去骨瓣减压术,出院时患者mRS评分4分;2例脑实质出血,1例死亡,1例停用双重抗血小板聚集药物后出现脑梗死,出院时mRS评分2分。结论破裂动脉瘤介入治疗后再出血病因复杂,对于手术操作性再出血,可根据患者情况调整抗血小板聚集药物应用方案,或行介入补救、外科联合治疗,或提高术者技术水平进行有效预防。

Objective To analyze the causes and prevention of cerebral rebleeding after stent-assisted embolization of ruptured intracranial aneurysmMethods A total of 655 patients who underwent single-stent-assisted spring coil embolization of an intracranial ruptured aneurysm from January 2011 to December 2017 in the First Affiliated Hospital of Zhengzhou University were selected. Of them, 16 patients with single aneurysms had perioperative surgery-related re-hemorrhage, 4 males and 12 females, aged 21 to 84 years. The re-hemorrhage and clinical outcomes of 16 patients were counted, and the modified Rankin (mRS) score was evaluated.Results The incidence of perioperative rebleeding in 655 patients was 2.4% (16/655). In the 16 cases, 9 cases had intraoper-ative aneurysm rebleeding, 5 cases died, 1 case had mRS score 4 points, and 3 cases mRS score 1 point. There were 7 cases of postoperative rebleeding, 5 cases of aneurysm rebleeding, 4 cases of death, 1 case of decompressive craniectomy after interventional therapy, and mRS score was 4 points at discharge. Two cases of brain parenchymal hemorrhage, 1 case of death, 1 case of cerebral infarction after discontinuation of dual antiplatelet aggregation drugs, mRS score was 2 points at discharge.Conclusions The causes of rebleeding after interventional treatment of ruptured aneurysm are complicated. For surgical rebleeding, the anti-platelet aggregation drugs application scheme can be adjusted according to the patients’situation, or interventional remedy, surgical combined treatment, effective technical level of operators can be used for effective prevention.