高纤维蛋白原血症颈动脉内膜剥脱术中紧急取栓1例报告并文献复习

Emergency thrombectomy in CEA with hyperfibrinogenemia:a case report and review of literature

目的探讨合并高纤维蛋白原血症(高纤血症)的短暂性脑缺血发作(TIA)患者颈动脉内膜剥脱(CEA)术后脑卒中发生的风险及防治策略。方法回顾分析1例颈内动脉狭窄合并高纤血症CEA术后发生血栓患者的临床资料;并结合相关文献复习对其临床表现、实验室检查、治疗过程及疗效进行分析。结果经术前检查明确为一侧颈内动脉重度狭窄合并高纤血症,予以降纤、降脂、抗血小板等治疗。2周后行CEA手术,过程顺利,患者术后出现即时脑卒中,立刻重新开放切口使用导管支架取栓成功,同时采用巴曲酶降纤治疗,神经功能恢复正常,影像学检查显示狭窄侧颈动脉血流通畅。术后根据凝血功能指标继续进行降纤、降脂和抗血小板治疗。结论高纤血症是动脉粥样硬化和脑卒中的独立危险因素,这类患者在施行CEA手术时,降纤治疗必须贯穿围手术期全过程,谨防术后即时脑卒中的发生。

Objective To investigate the risk and prevention strategy of carotid endarterectomy(CEA)in patients with transient ischemic attack(TIA)complicated with hyperfibrinogenemia.Methods The clinical data of a patient with internal carotid artery stenosis complicated concomitant hyperfibrinogenemia who developed thrombosis after CEA was analyzed retrospectively.The clinical manifestations,laboratory examination,treatment process were analyzed combined with relevant literature.Results The preoperative examination showed that one side of internal carotid artery was severely stenosed with hyperfibrinoemia.The patients were treated with defibrillation,lipid-lowering and antiplatelet therapy.CEA was performed 2 weeks later.The operation was successful,but stroke occurred immediately after the operation.The incision was reopened instantly,and the thrombus was removed successfully by catheter and stent technology.Batroxobin was used to reduce the fiber in the process.The neurological function recovered to normal after resuscitation and the imaging examination also showed that the carotid artery on the stenosis side has restored blood circulation.According to the coagulation function index after operation,the patient was continued to receive the treatment of reducing fiber,lipid and antiplatelet.Conclusions Hyperfibrinogenemia is an independent risk factor for atherosclerosis and stroke.During the operation of CEA,defibrillation therapy should be carried out throughout the whole process of the perioperative period,so as to prevent the occurrence of stroke immediately after operation.