短期加用替罗非班在支架辅助弹簧圈栓塞梭形动脉瘤中的安全性与有效性研究

doi:10.3877/cma.j.issn.2095-5782.2022.01.002

目的

评估支架辅助弹簧圈栓塞梭形动脉瘤术中及术后24 h内，在标准双抗血小板治疗的基础上，短期应用小剂量替罗非班在降低缺血并发症方面的安全性及有效性。

方法

回顾分析我中心2015年1月至2020年12月颅内未破裂梭形动脉瘤接受支架辅助弹簧圈栓塞治疗，并在手术过程中及术后24 h内静脉接受替罗非班（0.1 μg/kg/min）预防血小板聚集的患者资料。记录并分析围手术期并发症，动脉瘤栓塞程度及术后3个月随访时的mRS评分。

结果

本研究共纳入38例患者，39枚动脉瘤，动脉瘤平均直径（6.4±2.1）mm。其中，26枚动脉瘤接受了单支架辅助弹簧圈栓塞治疗，13枚动脉瘤接受了双支架辅助弹簧圈栓塞治疗。术后即刻78.9%（30/38）的动脉瘤实现完全栓塞；在26例接受脑血管造影复查的患者中，92.3%（24/26）的患者动脉瘤实现完全闭塞。围手术期缺血并发症发生率为7.9%（3/38）；无出血并发症发生。3个月随访的良好预后率为97.4%（37/38）（mRS评分为0~1分）。

结论

支架辅助弹簧圈栓塞梭形动脉瘤术中及术后24 h内，静脉加用小剂量替罗非班未增加出血并发症。但是，由于样本量偏少，缺少对比，在降低缺血并发症方面的有效性尚需进一步证实。

关键词: 梭形动脉瘤, 抗血小板, 替罗非班, 支架

Objective

To investigate the safety and efficacy of additional use of tirofiban during and within 24 h after the procedure in the treatment of intracranial fusiform aneurysms with stent-assisted coiling (SAC).

Methods

From January 2015 to December 2020, patients with intracranial fusiform aneurysms treated with SAC and intravenous administration of tirofiban 0.1 μg/kg/min were retrospectively collected in this study. The measured end points were rates of ischemic events, intracranial hemorrhage and 3 month modified Rankin Scale (mRS).

Results

A total of 38 patients with 39 aneurysms were identified. Stent-assisted coiling was successful in all cases with single stent-assisted in 26 aneurysms and double stent-assisted in 13 aneurysms , achieving immediate complete aneurysm occlusion in 78.9% (30/38). At 6-month angiographic follow-up, complete aneurysm occlusion was obtained in 92.3% (24/26). Ischemic complications were observed in 7.9% (3/38) of patients. No intracranial hemorrhage was noted. Good outcomes (mRS 0-1) were observed in 97.4% (37/38) of patients at the 3-month follow up.

Conclusions

Additional use of tirofiban during and within 24h after the procedure appears to be a safe treatment for fusiform aneurysms treated with SAC.

Key words: Fusiform aneurysms, Tirofiban, Antiplatelet, Stent

图1 患者男，50岁，因间歇性头晕2月余入院1A~1B：术前3D及造影提示右侧椎动脉梭形动脉瘤；1C：术后即刻造影提示瘤颈闭塞，Raymond分级Ⅰ级，载瘤动脉通畅；1D：患者3个月后造影复查，Raymond分级Ⅰ级，未见明显复发。

图2 患者女，71岁，因头晕头痛1周入院2A~2B：前3D及造影提示左侧颈内动脉梭形动脉瘤；2C：术后即刻造影提示瘤颈闭塞，Raymond分级Ⅰ级，载瘤动脉通畅；2D：术后1 h时出现右侧肢体偏瘫伴左侧凝视，急诊造影显示左侧颈内动脉末端闭塞；2E：微导管缓慢灌注20 mg rt-PA溶栓后支架内血流恢复；2F：术后头颅MRI提示左侧大脑半球皮层急性梗塞灶。

图3 患者男，61岁，因头晕1年余入院3A：术前造影提示左侧椎动脉动脉瘤；3B：术后即刻造影,Raymond分级Ⅱ级，载瘤动脉通畅；3C：患者术后出现肢体乏力，急查MR提示动脉瘤载瘤动脉对应区域新发梗塞灶；3D：患者3个月后造影复查，Raymond分级Ⅰ级，未见明显复发。

表1 患者mRS评分

mRS	术前（例）	术后（例）	3个月随访（例）
0	19	24	33
1	19	12	4
2	0	1	0
> 2	0	1	1

表1 患者mRS评分

mRS	术前（例）	术后（例）	3个月随访（例）
0	19	24	33
1	19	12	4
2	0	1	0
> 2	0	1	1

[1]	Kyeung Ko J, Weon Lee S, Hwa Choi C, et al. Endovascular reconstructive treatment using a fill-and-tunnel technique fora fusiform vertebral artery dissecting aneurysm with ipsilateral dominance[J]. Interv Neuroradiol, 2019, 25(5): 539-547.
[2]	van Oel LI, van Rooij WJ, Sluzewski M, et al. Reconstructive endovascular treatment of fusiform and dissecting basilar trunk aneurysms with flow diverters, stents, and coils[J]. AJNR Am J Neuroradiol, 2013, 34(3): 589-595.
[3]	Zhang Y, Tian Z, Sui B, et al. Endovascular treatment of spontaneous intracranial fusiform and dissecting aneurysms: outcomes related to imaging classification of 309 cases[J]. World Neurosurg, 2017, 98: 444-455.
[4]	Fischer S, Perez MA, Kurre W, et al. Pipeline embolization device for the treatment of intra- and extracranial fusiform and dissecting aneurysms: initial experience and long-term follow-up[J]. Neurosurgery, 2014, 75(4): 364-374.
[5]	Brinjikji W, Lanzino G, Cloft HJ, et al. Risk factors for ischemic complications following pipeline embolization device treatment of intracranial aneurysms: results from the IntrePED study[J]. AJNR Am J Neuroradiol, 2016, 37(9): 1673-1638.
[6]	Schneider DJ, Aggarwal A.Development of glycoproteinⅡb-Ⅲa antagonists: translation of pharmacodynamic effects into clinical benefit[J]. Expert Rev Cardiovasc Ther, 2004, 2(6): 903-913.
[7]	Wang ZL, Liang ZD, Li TX, et al. Intravenous administration of tirofiban versus loading dose of oral clopidogrel for preventing thromboembolism in stent-assisted coiling of intracranial aneurysms[J]. Int J Stroke, 2017, 12(5): 553-559.
[8]	Kim S, Choi JH, Kang M, et al. Safety and efficacy of intravenous tirofiban as antiplatelet premedication for stent-assisted coiling in acutely ruptured intracranial aneurysms[J]. AJNR Am J Neuroradiol, 2016, 37(3): 508-514.
[9]	Lee D, Lee DH, Park JC, et al. Timing of thrombosis in embolization of unruptured intracranial aneurysms: tirofiban as rescue treatment[J]. Clin Neuroradiol, 2021, 31(1): 125-133.
[10]	Moon J, Cho YD, Yoo DH, et al. Growth of asymptomatic intracranial fusiform aneurysms : incidence and risk factors[J]. Clin Neuroradiol, 2019, 29: 717-723.
[11]	Matsumoto Y, Iko M, Tsutsumi M, et al. The safety and efficacy of triple antiplatelet therapy after intracranial stent-assisted coil embolization[J]. J Stroke Cerebrovasc Dis, 2015, 24(7):1513-1519.
[12]	Ospel JM, Brouwer P, Dorn F, et al. Antiplatelet management for stent-assisted coiling and flow diversion of ruptured intracranial aneurysms: a DELPHI consensus statement[J]. AJNR Am J Neuroradiol, 2020, 41(10): 1856-1862.

[1]	杨城, 李祖儿, 刘青, 赵渊, 徐崇燕, 苏军, 张文云. 新型三维复合骨修复支架的制备工艺及其生物学性能[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(04): 219-229.
[2]	徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[3]	康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[4]	李佳伟, 庞建智, 闫鹏宇, 卫阳兵, 杨晓峰. 术中输尿管识别技术研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 520-524.
[5]	杨文刚, 赖义明, 黄浩, 黄海. 斜跨位上下联通置入Allium覆膜输尿管支架治疗输尿管狭窄的初步经验[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 340-345.
[6]	方道成, 陈立新, 胡媛媛. 输尿管支架结壳的相关研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 402-405.
[7]	马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[8]	韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[9]	石阳, 于剑锋, 曹可, 翟志伟, 叶春祥, 王振军, 韩加刚. 可扩张金属支架置入联合新辅助化疗治疗完全梗阻性左半结肠癌围手术期并发症分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 464-471.
[10]	梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[11]	张迪, 王春霞, 张学东, 李发馨, 庞淅文, 陈一锋, 张维胜, 王涛. 梗阻性左半结直肠癌自膨式金属支架置入后行腹腔镜手术与开腹手术的短期临床疗效比较[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 375-380.
[12]	胡子豪, 王喆, 陈建海, 齐岩松, 徐永胜. 聚合物材料在肩袖损伤治疗中的研究进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 362-368.
[13]	孙明策, 韩世焕. 海藻酸盐水凝胶支架在颅骨缺损修复中的应用进展[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 310-314.
[14]	神童, 申程, 张艳艳, 颜欣卓, 甘立军. 冠心病合并类风湿关节炎患者PCI术后死亡一例[J/OL]. 中华诊断学电子杂志, 2024, 12(04): 241-244.
[15]	牟磊, 徐东成, 韩鑫, 徐长江, 韩坤锜, 薛叶潇, 牟媛, 秦文玲, 刘相静, 陈哲, 高楠. 五虫通络胶囊防治椎动脉开口支架术后再狭窄发生的效果[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 467-472.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The safety and efficacy of additional use of tirofiban in the treatment of intracranial fusiform aneurysms with stent-assistedcoiling (SAC)

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The safety and efficacy of additional use of tirofiban in the treatment of intracranial fusiform aneurysms with stent-assistedcoiling (SAC)