Mayo Clinic Department of Radiology, 200 SW First St, Rochester, MN 55905, USA.
Stroke. 2013 May;44(5):1343-7. doi: 10.1161/STROKEAHA.111.000628. Epub 2013 Apr 18.
Acute intraprocedural thrombus formation complicating endovascular cerebral aneurysm treatment is often treated with intra-arterial or intravenous administration of thrombolytic agents or glycoprotein IIb/IIIa (GpIIb/IIIa) inhibitors. We sought to evaluate the morbidity and mortality associated with such treatments using a large multihospital database.
Using the Premier Perspective Database, we examined outcomes for patients receiving endovascular coiling for ruptured and unruptured aneurysms requiring rescue therapy, defined as treatment with GpIIb/IIIa inhibitors and fibrinolytic therapy. We compared discharge status, length of stay, and complication rates across 3 groups: (1) patients receiving GpIIb/IIIa inhibitors only, (2) patients receiving fibrinolytic therapy only, and (3) patients receiving both GpIIb/IIIa inhibitors and fibrinolytics. Student t test was used to compare continuous variables, and Fisher exact test was used to compare categorical variables.
Seven-percent (254/3627) of patients treated for unruptured aneurysms received rescue therapy. When compared with patients receiving GpIIb/IIIa inhibitors alone, patients receiving only fibrinolytics had significantly higher rates of discharge to institutions other than home (37.5% [9/24] versus 7.4% [15/201]; P<0.0001). Eight-percent of patients (338/4204) treated for ruptured aneurysms received rescue therapy. When compared with patients receiving GpIIb/IIIa inhibitors alone, patients receiving only fibrinolytics had significantly higher rates of mortality (26.0% [18/69] versus 14.5% [35/241]; P=0.02) and discharge to institutions other than home (59.4% [41/69] versus 36.5% [88/241]; P<0.0001).
Pharmacological rescue therapy occurred in 7% to 8% of endovascular coiling patients with unruptured and ruptured intracranial aneurysms. Rescue therapy with thrombolytic agents resulted in significantly more morbidity and mortality than rescue therapy with GpIIb/IIIa inhibitors.
急性血管内血栓形成是血管内脑动脉瘤治疗过程中的常见并发症，通常采用动脉内或静脉内给予溶栓药物或糖蛋白 IIb/IIIa（GpIIb/IIIa）抑制剂进行治疗。本研究旨在利用大型多医院数据库评估此类治疗的发病率和死亡率。
利用 Premier Perspective 数据库，我们分析了因需要挽救性治疗（定义为 GpIIb/IIIa 抑制剂和纤维蛋白溶解治疗）而接受血管内线圈栓塞治疗的破裂和未破裂动脉瘤患者的结局。我们比较了 3 组患者的出院情况、住院时间和并发症发生率：（1）仅接受 GpIIb/IIIa 抑制剂治疗的患者，（2）仅接受纤维蛋白溶解治疗的患者，和（3）同时接受 GpIIb/IIIa 抑制剂和纤维蛋白溶解治疗的患者。采用 Student t 检验比较连续变量，采用 Fisher 确切概率法比较分类变量。
7%（254/3627）的未破裂动脉瘤患者接受了挽救性治疗。与仅接受 GpIIb/IIIa 抑制剂治疗的患者相比，仅接受纤维蛋白溶解治疗的患者出院后前往非家庭机构的比例显著更高（37.5%[9/24] vs. 7.4%[15/201]；P<0.0001）。8%（338/4204）的破裂动脉瘤患者接受了挽救性治疗。与仅接受 GpIIb/IIIa 抑制剂治疗的患者相比，仅接受纤维蛋白溶解治疗的患者死亡率显著更高（26.0%[18/69] vs. 14.5%[35/241]；P=0.02），出院后前往非家庭机构的比例也更高（59.4%[41/69] vs. 36.5%[88/241]；P<0.0001）。
未破裂和破裂颅内动脉瘤血管内线圈栓塞患者中，有 7%至 8%接受了药物性挽救性治疗。与 GpIIb/IIIa 抑制剂挽救性治疗相比，溶栓治疗导致的发病率和死亡率显著更高。
