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

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

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