替罗非班治疗颅内动脉瘤介入围手术期支架内血栓的单中心经验

Tirofiban for Periprocedural In-stent Thrombosis during Stent-assisted Coiling of Intracranial Aneurysms:A Single Center Experience

目的探讨应用替罗非班治疗颅内动脉瘤支架辅助栓塞围手术期支架内血栓的有效性及安全性。方法回顾性分析2018年6月-2020年12月于华中科技大学同济医学院附属同济医院神经外科行支架辅助颅内动脉瘤栓塞术围手术期发生支架内血栓患者的临床资料,评估应用替罗非班对支架辅助颅内动脉瘤栓塞术围手术期血栓的治疗效果,包括血栓是否溶通、围手术期出血发生率及出院时mRS评分。结果177例接受支架辅助弹簧圈栓塞术的患者中,12例(6.8%)发生围手术期血栓事件,年龄中位数56.5岁,女性11例(91.7%),均为未破裂动脉瘤。前循环动脉瘤10例(83.3%),后循环动脉瘤2例(16.7%)。4例(33.3%)选用了激光雕刻支架,8例(66.7%)选用了编织支架。术中发生血栓事件者9例(85.0%),术后发生血栓事件3例(15.0%)。应用替罗非班后,12例支架内血栓均成功溶通,其中1例发生颅内出血事件,出院时预后不良(mRS 4分);其余11例(91.7%)均无相关并发症,预后良好(均mRS 0分)。结论支架辅助弹簧圈栓塞颅内动脉瘤围手术期出现支架内血栓时,应用替罗非班是一种安全、有效的治疗方法。

Objective To investigate the efficacy and safety of tirofiban in treatment of periprocedural in-stent thrombosis during stent-assisted coiling of intracranial aneurysms.Methods This retrospective analysis enrolled the patients with perioprocedural in-stent thrombosis during stent-assisted coiling for intracranial aneurysms at Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from June 2018 to December 2020.The clinical data of all the patients were analyzed to evaluate the efficacy and safety of tirofiban for periprocedural thrombosis,and the assessment indexes included the thrombus dissolution rate,periprocedural bleeding and mRS score at discharge.Results Of 177 patients who underwent stent-assisted coil embolization,12 cases(6.8%)had periprocedural thrombotic events,with a median age of 56.5 years and 11(91.7%)females,including 10 cases(83.3%)with anterior circulation aneurysms and 2 cases(16.7%)with posterior circulation aneurysms,all of which were unruptured aneurysms.Laser sculpting stents were used in 4 cases(33.3%)and braided stents were used in 8 cases(66.7%).Intraprocedural thrombotic events occurred in 9 cases(85.0%),and postprocedural thrombotic events occurred in 3 cases(15.0%).After the application of tirofiban,the thrombus was successfully dissolved in all 12 patients.Only one patient had an intracerebral hemorrhage after using tirofiban,and this patient had a poor prognosis(mRS 4 points)at discharge,and the remaining 11 patients(91.7%)had no complication and they all had a good prognosis(all mRS 0 point).Conclusions The application of tirofiban is a safe and effective treatment for periprocedural instent thrombosis during stent-assisted coiling of intracranial aneurysms.