Iwasaki M, Ezura M, Takahashi A, Yoshimoto T
Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan.
No Shinkei Geka. 1999 Aug;27(8):757-61.
We report a case of a ruptured middle cerebral artery (MCA) aneurysm treated by an intra-aneurysmal Guglielmi detachable coil (GDC) embolization in a patient with idiopathic thrombocytopenic purpura (ITP). A 57-year-old female, who had been suffering from ITP for 4 years, experienced sudden severe headache. She was diagnosed as having subarachnoid hemorrhage due to a ruptured MCA aneurysm and the hematological examination showed moderate thrombocytopenia. Considering the risk of open surgery, we treated the aneurysm by intra-aneurysmal GDC embolization in the acute stage and platelet transfusion was carried out after the therapy. She had a good clinical course and recovered without any complications or neurological symptoms. The follow-up cerebral angiogram at 1 week and 2 years after the treatment showed complete obliteration of the aneurysm. Recently, endovascular treatment tends to be applied to surgically high-risk patients. A GDC embolization for a patient with thrombocytopenia has rarely been reported and the risk and efficacy is unknown. So, we conclude that for a patient with thrombocytopenia, intra-aneurysmal GDC embolization could be adopted as one of the less invasive treatment for ruptured aneurysm.
我们报告一例患有特发性血小板减少性紫癜（ITP）的患者，其大脑中动脉（MCA）动脉瘤破裂后接受了动脉瘤内 Guglielmi 可脱卸弹簧圈（GDC）栓塞治疗。一名 57 岁女性，患 ITP 已 4 年，突发剧烈头痛。她被诊断为因 MCA 动脉瘤破裂导致蛛网膜下腔出血，血液学检查显示中度血小板减少。考虑到开颅手术的风险，我们在急性期通过动脉瘤内 GDC 栓塞治疗该动脉瘤，并在治疗后进行了血小板输注。她临床过程良好，康复后无任何并发症或神经症状。治疗后 1 周和 2 年的随访脑血管造影显示动脉瘤完全闭塞。近来，血管内治疗倾向于应用于手术高危患者。针对血小板减少患者的 GDC 栓塞治疗鲜有报道，其风险和疗效未知。因此，我们得出结论，对于血小板减少患者，动脉瘤内 GDC 栓塞可作为破裂动脉瘤的一种微创治疗方法。
