Bruening R, Mueller-Schunk S, Morhard D, Seelos K C, Brueckmann H, Schmid-Elsaesser R, Straube A, Mayer T E
Departments of Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilian University Munich, Munich, Germany.
AJNR Am J Neuroradiol. 2006 Jun-Jul;27(6):1326-31.
When using detachable coils to treat intracranial aneurysms, thromboembolism is the most feared and frequently reported complication during or after endovascular therapy. The purpose of this study was to document the therapeutic effect of tirofiban on patency of the parent vessel, rate of rebleedings, and outcome of the patients in the setting of acute subarachnoidal hemorrhage.
A patient data base was retrospectively reviewed to identify patients in whom thrombus occurred during endovascular treatment of ruptured cerebral aneurysms within a 34-month period and who were treated with tirofiban. All patients underwent anticoagulation with heparin during endovascular treatment procedures. Sixteen patients (age range, 52.9 +/- 10.7 years; 10 women, 6 men) were identified with intraprocedural thrombus formation. The patency of the parent vessel was assessed in a retrospective analysis blinded to outcome. Eight patients received ventriculostomy and had a follow-up CT.
Local nonocclusive thrombus at the coil surface was detected in 5 patients, in all of whom the thrombus was dissolved. In 10 patients, partial or total occlusion of the parent vessel occurred during the intervention; in 8 of these, the vessel was recanalized completely and in 2 drug administration was assisted by mechanical means. In 1 patient, however, the occlusion persisted. No periprocedural rebleedings of the ruptured aneurysm occurred; 3 of 8 ventriculostomies had clinically silent small local bleedings.
The use of tirofiban in the setting of endovascular treatment of ruptured intracranial aneurysms to dissolve platelet aggregation seems relatively safe and effective.
在使用可脱卸弹簧圈治疗颅内动脉瘤时，血栓栓塞是血管内治疗期间或之后最令人担忧且报道频繁的并发症。本研究的目的是记录替罗非班在急性蛛网膜下腔出血情况下对载瘤血管通畅性、再出血率及患者预后的治疗效果。
回顾性分析患者数据库，以确定在34个月期间内破裂脑动脉瘤血管内治疗过程中发生血栓且接受替罗非班治疗的患者。所有患者在血管内治疗过程中均接受肝素抗凝。确定16例患者（年龄范围52.9±10.7岁；女性10例，男性6例）发生术中血栓形成。在对结果不知情的回顾性分析中评估载瘤血管的通畅性。8例患者接受了脑室造瘘术并进行了CT随访。
5例患者在弹簧圈表面检测到局部非闭塞性血栓，所有这些血栓均溶解。10例患者在干预期间发生载瘤血管部分或完全闭塞；其中8例血管完全再通，2例通过机械手段辅助给药。然而，1例患者闭塞持续存在。破裂动脉瘤围手术期未发生再出血；8例脑室造瘘术中3例有临床上无症状的局部小出血。
在破裂颅内动脉瘤血管内治疗中使用替罗非班溶解血小板聚集似乎相对安全有效。
