Baptist Cardiac and Vascular Institute, Miami, Florida, USA.
J Neurointerv Surg. 2010 Jun;2(2):135-8. doi: 10.1136/jnis.2009.001933.
Thrombus formation during endovascular embolization of intracranial aneurysms occurs in 2.9%-6% of patients. Use of IIb/IIIA inhibitors such as abciximab or eptifibatide intravenously has been reported in management of this complication. Because the intra-arterial infusion of IIb/IIIA inhibitors may require lower doses to achieve thrombolysis, it may reduce the risk of haemorrhage. Therefore, we retrospectively analyze our database and review the literature.
This is a retrospective analysis of a prospectively acquired database of patients with ruptured or unruptured aneurysm treated intra-arterially for thrombus formation during endovascular coil embolization between July 2005 and August 2008. Patient demographics, aneurysmal characteristics, procedural, clinical outcome and complications were recorded.
From July 2005 to August 2008, out of 184 patients who underwent coil embolization, 19 patients (15 smokers, 14 female, mean age 52) developed intraprocedural thrombus formation and received intra-arterial abciximab treatment. Mean aneurysm size was 6.6 mm±4.9 mm; neck size was 3.8 mm±2.1 mm. Eight (42.1%) aneurysms were ruptured. Most aneurysms (63.1%) were in anterior communicating and middle cerebral arteries. Thrombus was visualized in all cases by angiogram and treated intra-arterially with a mean dose of 10.5 mg±4.2. There were no periprocedural hemorrhagic complications. No deaths or other complications occurred during follow-up.
Thrombus formation during coil embolization of intracranial aneurysms occurred more in women and smokers. Low doses of intra-arterial abciximab may be effective in the thromboembolic complications occurring during endovascular embolization of intracranial aneurysms.
血管内栓塞颅内动脉瘤过程中，有 2.9%-6%的患者会发生血栓形成。已有报道称，在处理这种并发症时，可静脉内使用 IIb/IIIA 抑制剂，如阿昔单抗或依替巴肽。由于动脉内输注 IIb/IIIA 抑制剂可能需要较低的剂量来实现溶栓，因此可能会降低出血风险。因此，我们回顾了我们的数据库并复习了文献。
这是一项回顾性分析，纳入了 2005 年 7 月至 2008 年 8 月期间，因血管内线圈栓塞过程中发生血栓形成而接受治疗的破裂或未破裂动脉瘤患者的前瞻性采集数据库。记录了患者的人口统计学、动脉瘤特征、程序、临床结果和并发症。
2005 年 7 月至 2008 年 8 月，在 184 例行线圈栓塞的患者中，19 例（15 例吸烟者，14 例女性，平均年龄 52 岁）发生术中血栓形成，并接受了动脉内阿昔单抗治疗。平均动脉瘤大小为 6.6mm±4.9mm；瘤颈大小为 3.8mm±2.1mm。8 例（42.1%）动脉瘤破裂。大多数动脉瘤（63.1%）位于前交通和大脑中动脉。所有病例均通过血管造影显示血栓，并经动脉内给予平均剂量 10.5mg±4.2mg 进行治疗。围手术期无出血性并发症。随访期间无死亡或其他并发症发生。
颅内动脉瘤线圈栓塞过程中血栓形成在女性和吸烟者中更为常见。动脉内低剂量阿昔单抗可能对颅内动脉瘤血管内栓塞过程中发生的血栓栓塞性并发症有效。
