Department of Neurology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
J Neurointerv Surg. 2010 Mar;2(1):23-30. doi: 10.1136/jnis.2009.001693. Epub 2009 Dec 4.
Antiplatelet agents are required to prevent thromboembolic complications from recently deployed intracranial stents, yet they carry a risk of bleeding complications that may be serious in patients with recent subarachnoid hemorrhage.
Consecutive patients at a single institution who had ruptured intracranial saccular aneurysms treated with stent assisted coiling were retrospectively reviewed. Our primary outcomes were ischemic stroke related to the stent and bleeding complications possibly related to antithrombotic therapy. Secondary outcomes included 3 month follow-up National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores.
44 aneurysms in 42 patients were treated. Seven patients experienced ischemic strokes during their hospitalization. Five ischemic strokes were secondary to vasospasm; one was definitely related to thrombus formation within the stent and one was possibly related to the stent. Two patients had asymptomatic intracranial hemorrhages and one patient had a symptomatic intracranial hemorrhage. Patients with Hunt and Hess grades I-II (n=25) experienced no stent associated ischemic strokes or symptomatic intracranial hemorrhages. The two stent associated ischemic strokes and one symptomatic intracranial hemorrhage occurred in patients with Hunt and Hess grades III-V (n=17) and patients with external ventricular drains (EVDs) (n=17). Only one patient had disability at the 3 month follow-up that was possibly related to the stent (mRS score of 3 and NIHSS score of 2).
These data suggest that higher grade hemorrhage patients, especially those with EVDs, are at greater risk for ischemic stroke and/or bleeding complications than lower grade patients. However, the complications had a small impact on mid-term disability outcomes in this cohort.
为了预防新近放置的颅内支架引起的血栓栓塞并发症，需要使用抗血小板药物，但这可能会增加有近期蛛网膜下腔出血的患者发生出血并发症的风险，且这些并发症可能很严重。
对一家机构连续收治的因颅内囊状破裂动脉瘤而接受支架辅助弹簧圈治疗的患者进行回顾性研究。我们的主要结局是支架相关的缺血性卒中以及可能与抗血栓治疗相关的出血并发症。次要结局包括 3 个月时的国立卫生研究院卒中量表（NIHSS）评分和改良 Rankin 量表（mRS）评分。
42 例患者的 44 个动脉瘤接受了治疗。7 例患者在住院期间发生缺血性卒中。5 例缺血性卒中继发于血管痉挛，1 例肯定与支架内血栓形成有关，1 例可能与支架有关。2 例患者发生无症状性颅内出血，1 例患者发生症状性颅内出血。Hunt 和 Hess 分级 I-II 级（n=25）的患者未发生支架相关的缺血性卒中和症状性颅内出血。2 例支架相关的缺血性卒中和 1 例症状性颅内出血发生在 Hunt 和 Hess 分级 III-V 级（n=17）和有外部脑室引流（EVD）（n=17）的患者中。只有 1 例患者在 3 个月随访时有残疾，可能与支架有关（mRS 评分 3 分，NIHSS 评分 2 分）。
这些数据表明，较高分级的出血患者，尤其是有 EVD 的患者，发生缺血性卒中和/或出血并发症的风险高于较低分级的患者。然而，在这一队列中，并发症对中期残疾结局的影响较小。
