超选择注射替罗非班治疗颅内动脉瘤栓塞术中急性血栓形成的临床疗效
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摘要
目的探讨经动脉超选择注射替罗非班治疗颅内动脉瘤栓塞术中急性血栓形成的临床疗效及安全性。方法将23例在进行介入栓塞动脉瘤时出现急性血栓形成的患者分成2组,替罗非班组13例,在发现血栓形成后立即将微导管头端送到血栓形成部位,通过微导管缓慢注入替罗非班溶解血栓;尿激酶组10例,在发现血栓后同样通过微导管缓慢注入尿激酶溶解血栓;术后2组患者治疗方案基本一致,记录及对比术中治疗后闭塞血管的再通情况、术后出现缺血及出血等并发症的情况,并在治疗3个月后使用格拉斯哥预后评分对比2组患者的预后。结果 2组患者治疗后DSA显示动脉瘤均被致密栓塞,血栓形成的血管均再通良好,替罗非班组平均再通时间(35±7)min明显短于尿激酶组的(52±14)min;术后2组患者均无颅内出血事件发生,替罗非班组出现1例迟发性脑缺血,尿激酶组出现3例迟发性脑缺血,2组比较有明显差异(P=0.012);2组患者治疗3个月后的改良mRS评分比较无明显差异(P>0.05)。结论在介入栓塞动脉瘤出现急性血栓形成时使用微导管靶向注射替罗非班溶栓是一种有效及安全的治疗方法。
Objective To investigate the clinical efficacy and the safety of transarterial superselective Tirofiban injection in acute thrombosis treatment during intracranial aneurysm embolization.Methods 23 cases of patients with acute thrombosis during interventional aneurysm embolization were divided into two groups.In the 13 cases of Tirofiban group when thrombus formatted the head ends of the micro catheter was immediately sent to the formation site,then Tirofiban was slowly injected to dissolve the thrombus through the catheter.In the 10 cases of Urokinase group other operation was the same as the former group,only Urokinase instead of Tirofiban.The postoperative schemes of the two groups were basically the same.The recanalization of the obliterans and the complications such as ischemia and bleeding after operation were recorded,and the prognosis of the two groups was compared by the Glasgow prognosis score after 3 months.Results After the treatment of the two groups,DSA showed that all the aneurysms were dense embolism,the blood vessels formed in the thrombus were recanalized well,the average recanalization time of the Tirofiban group was(35±7)min,shorter than that of the Urokinase group(52±14)min.There were no intracranial hemorrhage in the two groups after operation,1 case emerged delayed cerebral ischemia in the Tirofiban group,and 3 cases emerged the same in the Urokinase group.The difference between the two groups was statistically significant(P=0.012).There was no significant difference in the modified mRS score between the two groups after 3 months(P>0.05).Conclusion It was effective and safe to inject Tirofiban to dissolve the thrombus through micro catheter when acute thrombus formatted during intracranial aneurysm embolization.
Objective To investigate the clinical efficacy and the safety of transarterial superselective Tirofiban injection in acute thrombosis treatment during intracranial aneurysm embolization.Methods 23 cases of patients with acute thrombosis during interventional aneurysm embolization were divided into two groups.In the 13 cases of Tirofiban group when thrombus formatted the head ends of the micro catheter was immediately sent to the formation site,then Tirofiban was slowly injected to dissolve the thrombus through the catheter.In the 10 cases of Urokinase group other operation was the same as the former group,only Urokinase instead of Tirofiban.The postoperative schemes of the two groups were basically the same.The recanalization of the obliterans and the complications such as ischemia and bleeding after operation were recorded,and the prognosis of the two groups was compared by the Glasgow prognosis score after 3 months.Results After the treatment of the two groups,DSA showed that all the aneurysms were dense embolism,the blood vessels formed in the thrombus were recanalized well,the average recanalization time of the Tirofiban group was(35±7)min,shorter than that of the Urokinase group(52±14)min.There were no intracranial hemorrhage in the two groups after operation,1 case emerged delayed cerebral ischemia in the Tirofiban group,and 3 cases emerged the same in the Urokinase group.The difference between the two groups was statistically significant(P=0.012).There was no significant difference in the modified mRS score between the two groups after 3 months(P>0.05).Conclusion It was effective and safe to inject Tirofiban to dissolve the thrombus through micro catheter when acute thrombus formatted during intracranial aneurysm embolization.
引文
[1]魏社鹏,赵继宗.未破裂颅内动脉瘤的研究进展[J].国际神经病学神经外科学杂志,2017,44(3):311-315.
[2]Kim JS,Nah HW,Park SM,et al.Risk factors and stroke mechanisms in atherosclerotic stroke[J].Stroke,2012,43(12):3313.
[3]Ryu CW,Park S,Shin HS,et al.Complications in Stent-Assisted endovascular therapy of ruptured intracranial aneurysms and relevance to antiplatelet administration:a systematic review[J].AJNR Am J Neuroradiol,2015,36(9):1682-1688.
[4]Derdeyn CP,Cross DT,Moran CJ,et al.Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils[J].J Neurosurg,2002,96(5):837-843.
[5]Brinjikji W,Mcdonald JS,Kallmes DF,et al.Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms[J].Stroke,2013,44(5):1343-1347.
[6]Cho YD,Lee JY,Seo JH,et al.Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms[J].Eur J Radiol,2012,81(10):2833-2838.
[7]Berkhemer OA,Fransen PS,Beumer D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].NEngl J Med,2015,372(1):11-20.
[8]Gijn JV,Kerr RS,Rinkel GE.Subarachnoid haemorrhage.Lancet[J].Lancet,2007,369(9558):306-318.
[9]Molyneux AJ,Birks J,Clarke A,et al.The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms:18year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial(ISAT)[J].Lancet,2015,385(9969):691-697.
[10]Molyneux A,Kerr R,International Subarachnoid Aneurysm Trial(ISAT)Collaborative Group,et al.International subarachnoid aneurysm trial(ISAT)of neurosurgical clipping versus endovascular coiling in 2143patients with ruptured intracranial aneurysms:a randomized trial[J].J Stroke Cerebrovasc Dis,2007,11(6):304-314.
[11]Ciccone A,Santilli I.Glycoprotein IIb-IIIa inhibitors for acute ischemic stroke[J].Cochrane Database of Systematic Reviews,2014,3(8):CD005208.
[12]Gori AM,Marcucci R,Migliorini A,et al.Incidence and clinical impact of dual nonresponsiveness to aspirin and clopidogrel in patients with drug-eluting stents[J].J Am Coll Cardiol,2008,52(9):734-739.
[13]Ohkuma H,Tsurutani H,Suzuki S.Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management[J].Stroke,2001,32(5):1176-1180.
[14]Deshmukh VR,Fiorella DJ,Albuquerque FC,et al.Intra-arterial thrombolysis for acute ischemic stroke:preliminary experience with platelet glycoprotein IIb/IIIa inhibitors as adjunctive therapy[J].Neurosurgery,2005,56(1):46-54;discussion 54-5.
[15]Siebler M,Hennerici MG,Schneider D,et al.Safety of tirofiban in acute ischemic stroke:the SaTIS trial[J].Stroke,2011,42(9):2388-2392.
[2]Kim JS,Nah HW,Park SM,et al.Risk factors and stroke mechanisms in atherosclerotic stroke[J].Stroke,2012,43(12):3313.
[3]Ryu CW,Park S,Shin HS,et al.Complications in Stent-Assisted endovascular therapy of ruptured intracranial aneurysms and relevance to antiplatelet administration:a systematic review[J].AJNR Am J Neuroradiol,2015,36(9):1682-1688.
[4]Derdeyn CP,Cross DT,Moran CJ,et al.Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils[J].J Neurosurg,2002,96(5):837-843.
[5]Brinjikji W,Mcdonald JS,Kallmes DF,et al.Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms[J].Stroke,2013,44(5):1343-1347.
[6]Cho YD,Lee JY,Seo JH,et al.Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms[J].Eur J Radiol,2012,81(10):2833-2838.
[7]Berkhemer OA,Fransen PS,Beumer D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].NEngl J Med,2015,372(1):11-20.
[8]Gijn JV,Kerr RS,Rinkel GE.Subarachnoid haemorrhage.Lancet[J].Lancet,2007,369(9558):306-318.
[9]Molyneux AJ,Birks J,Clarke A,et al.The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms:18year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial(ISAT)[J].Lancet,2015,385(9969):691-697.
[10]Molyneux A,Kerr R,International Subarachnoid Aneurysm Trial(ISAT)Collaborative Group,et al.International subarachnoid aneurysm trial(ISAT)of neurosurgical clipping versus endovascular coiling in 2143patients with ruptured intracranial aneurysms:a randomized trial[J].J Stroke Cerebrovasc Dis,2007,11(6):304-314.
[11]Ciccone A,Santilli I.Glycoprotein IIb-IIIa inhibitors for acute ischemic stroke[J].Cochrane Database of Systematic Reviews,2014,3(8):CD005208.
[12]Gori AM,Marcucci R,Migliorini A,et al.Incidence and clinical impact of dual nonresponsiveness to aspirin and clopidogrel in patients with drug-eluting stents[J].J Am Coll Cardiol,2008,52(9):734-739.
[13]Ohkuma H,Tsurutani H,Suzuki S.Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management[J].Stroke,2001,32(5):1176-1180.
[14]Deshmukh VR,Fiorella DJ,Albuquerque FC,et al.Intra-arterial thrombolysis for acute ischemic stroke:preliminary experience with platelet glycoprotein IIb/IIIa inhibitors as adjunctive therapy[J].Neurosurgery,2005,56(1):46-54;discussion 54-5.
[15]Siebler M,Hennerici MG,Schneider D,et al.Safety of tirofiban in acute ischemic stroke:the SaTIS trial[J].Stroke,2011,42(9):2388-2392.