Fiehler Jens, Ries Thorsten
Department of Neuroradiology, University Hospital Eppendorf, Hamburg, Germany.
Klin Neuroradiol. 2009 Mar;19(1):73-81. doi: 10.1007/s00062-009-8029-9. Epub 2009 May 15.
Thromboembolic events with partially or completely persisting neurologic deficits are reported in a substantial number of patients after endovascular aneurysm therapy. The authors discuss the current status of periinterventional coagulation management in endovascular aneurysm therapy. First, some basic aspects of coagulation physiology relevant to neurointerventions are introduced. Second, the most important pharmacological aspects of heparin, protamine sulfate, low-molecular-weight heparin, tissue plasminogen activator, acetylsalicylic acid, clopidogrel, abciximab, tirofiban and eptifibatide for neurointerventions are considered. Third, the use of these drugs in periinterventional coagulation management are discussed with special emphasis on current standards in anticoagulation/antiplatelet strategy and their impact on aneurysm perforation rates. Moreover, treatment of thrombotic complications of endovascular therapy of cerebral aneurysms is discussed.
大量接受血管内动脉瘤治疗的患者报告出现了伴有部分或完全持续性神经功能缺损的血栓栓塞事件。作者讨论了血管内动脉瘤治疗中围手术期凝血管理的现状。首先，介绍了与神经介入相关的凝血生理的一些基本方面。其次，考虑了肝素、硫酸鱼精蛋白、低分子量肝素、组织纤溶酶原激活剂、乙酰水杨酸、氯吡格雷、阿昔单抗、替罗非班和依替巴肽在神经介入方面最重要的药理学方面。第三，讨论了这些药物在围手术期凝血管理中的应用，特别强调了抗凝/抗血小板策略的当前标准及其对动脉瘤穿孔率的影响。此外，还讨论了脑动脉瘤血管内治疗血栓并发症的治疗。
