Alexander Michael J, Duckwiler Gary R, Gobin Y Pierre, Viñuela Fernando
Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Neurosurgery. 2002 Apr;50(4):899-901; discussion 901-2. doi: 10.1097/00006123-200204000-00045.
Thromboembolic complications after cerebral aneurysm treatment with Guglielmi detachable coils (Boston Scientific/Target, Fremont, CA) are not infrequent; in a University of California, Los Angeles institutional review of 720 treated aneurysms, thromboembolic complications occurred in 2.5% of cases. The development of intraluminal thrombus during the embolization procedure, however, may be diagnosed promptly and treated effectively with appropriate therapy. This report describes the use of intravenously administered abciximab for the treatment of intraprocedural arterial thrombus encountered during the coil embolization of a recently ruptured anterior communicating artery aneurysm.
A 45-year-old man presented with severe headache 12 days before transfer to our institution. He had no neurological deficits at admission. Previous computed tomography of the brain demonstrated subarachnoid hemorrhage, and magnetic resonance angiography from the other institution demonstrated a 4-mm anterior communicating artery aneurysm.
The patient underwent Guglielmi detachable coil embolization of the aneurysm under systemic heparinization. During the embolization, however, a thrombus developed in the proximal left A2 segment. The patient was given an intravenous infusion (20 mg) of abciximab for 10 minutes, and within 15 minutes dissolution of the thrombus was observed with no angiographic evidence of distal emboli. After reversal of general anesthesia, the patient exhibited minimal right leg weakness, which resolved within 1 hour.
Abciximab may be a useful adjunct for endovascular treatment of patients with cerebral aneurysms in whom intraprocedural arterial thrombus is encountered.
使用 Guglielmi 可脱卸弹簧圈（波士顿科学公司/Target，加利福尼亚州弗里蒙特）治疗脑动脉瘤后血栓栓塞并发症并不罕见；在加利福尼亚大学洛杉矶分校对 720 例接受治疗的动脉瘤进行的机构回顾中，血栓栓塞并发症发生在 2.5%的病例中。然而，在栓塞过程中管腔内血栓的形成可通过适当治疗迅速诊断并有效治疗。本报告描述了静脉注射阿昔单抗用于治疗在最近破裂的前交通动脉瘤弹簧圈栓塞过程中遇到的术中动脉血栓。
一名 45 岁男性在转至我院前 12 天出现严重头痛。入院时无神经功能缺损。此前脑部计算机断层扫描显示蛛网膜下腔出血，另一机构的磁共振血管造影显示一个 4 毫米的前交通动脉瘤。
患者在全身肝素化下接受了动脉瘤的 Guglielmi 可脱卸弹簧圈栓塞术。然而，在栓塞过程中，左 A2 段近端形成了血栓。给患者静脉输注阿昔单抗（20 毫克）10 分钟，15 分钟内观察到血栓溶解，血管造影未显示远端栓子迹象。全身麻醉苏醒后，患者出现轻微右腿无力，1 小时内缓解。
对于在脑动脉瘤血管内治疗过程中遇到术中动脉血栓的患者，阿昔单抗可能是一种有用的辅助药物。
