Ross Ian B, Dhillon Gurmeet S
Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS 39216, USA.
AJNR Am J Neuroradiol. 2003 Sep;24(8):1528-31.
Recent evidence suggests that endovascular treatment of acutely ruptured aneurysms is equivalent, if not superior, to surgical treatment. Not all patients who undergo endovascular treatment do well, however. We have identified ventriculostomy-related hemorrhage to be a potential source of morbidity and mortality.
Prospectively gathered data on patients (n = 51) admitted to a hospital for the endovascular treatment of acutely ruptured aneurysms during a 2.5-year period was analyzed.
Twenty-four patients had drains inserted, and three suffered symptomatic ventriculostomy-related cerebral hemorrhages. Two of the three patients were being treated with heparin, one of whom also received clopidogrel, and the third was being treated with low molecular weight heparin at the time. The latter had a normal platelet count, prothrombin time, and activated partial thromboplastin time. All cerebral hemorrhages were deemed to have occurred as a result of drain manipulation.
The risk of hemorrhage must be considered when using anticoagulation and antiplatelet therapy in patients requiring ventriculostomy. Interventionalists must not only work closely with neurosurgeons when it is anticipated that a ventriculostomy may be needed but also ensure that there is good communication with the neurosurgical team during the postprocedural period.
近期证据表明，急性破裂动脉瘤的血管内治疗即便不比外科治疗优越，至少也是等效的。然而，并非所有接受血管内治疗的患者都预后良好。我们已确定脑室造瘘相关出血是发病和死亡的一个潜在来源。
分析了在2.5年期间前瞻性收集的因急性破裂动脉瘤接受血管内治疗而入住一家医院的患者（n = 51）的数据。
24例患者插入了引流管，3例出现了有症状的脑室造瘘相关脑出血。3例患者中有2例正在接受肝素治疗，其中1例还接受了氯吡格雷治疗，第3例当时正在接受低分子量肝素治疗。后者血小板计数、凝血酶原时间和活化部分凝血活酶时间均正常。所有脑出血均被认为是由于引流管操作所致。
在需要脑室造瘘的患者中使用抗凝和抗血小板治疗时，必须考虑出血风险。介入医生不仅在预计可能需要脑室造瘘时必须与神经外科医生密切合作，而且在术后期间也要确保与神经外科团队保持良好沟通。
