Department of Neurosurgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama 640-8505, Japan.
Acta Neurochir (Wien). 2013 Aug;155(8):1549-57. doi: 10.1007/s00701-013-1771-4. Epub 2013 May 29.
Dual antiplatelet therapy for stent-assisted coiling of cerebral aneurysms is essential to prevent thromboembolic complications. There is concern that Y-stent-assisted coiling may increase thromboembolic complications compared with coiling with a single stent. Several reports have demonstrated that cilostazol may improve clopidogrel responsiveness. We investigated whether triple antiplatelet therapy with addition of cilostazol to aspirin plus clopidogrel for Y-stents can prevent thromboembolic events.
Between July 2010 and October 2012, we treated 40 consecutive aneurysms with coil embolization using Enterprise stents. At the peri-procedural period, dual antiplatelet agents (100 mg aspirin and 75 mg clopidogrel) were used for the single stent group (n = 36), and triple antiplatelet agents (addition of 200 mg cilostazol) were used for the Y-stent group (n = 4). We evaluated post-operative diffusion-weighted imaging (DWI) and any complications. We assessed the following for statistical analysis: age, sex, aneurysm location, shape, and size, neck size, size of parent vessels, and stent length.
We found two neurological peri-procedural complications: one transient ischemic attack and one infarction. Both complications belonged to the Y-stent group, which was a significant factor of thromboembolic events (P = 0.008). There were no other significant factors related to neurological complications or positive DWI. For subgroup analysis of the single stent group, stent length was significantly longer in positive DWI than negative DWI (P = 0.04). In the follow-up period of 20 ± 8.6 months, there were no symptomatic late complications in any patients.
Although the number of patients in the Y-stent group is small, this group had a significantly higher risk of thromboembolic complications. While our protocol of a routine dose of dual antiplatelet therapy may be sufficient for single stent therapy, our protocol of a routine dose of triple antiplatelet therapy for Y-stents may not prevent thromboembolic events. This suggests that evaluation of platelet function may be essential, especially for Y-stents.
支架辅助弹簧圈栓塞治疗颅内动脉瘤时需要双联抗血小板治疗，以预防血栓栓塞并发症。人们担心 Y 型支架辅助弹簧圈栓塞术与单纯支架治疗相比可能会增加血栓栓塞并发症。一些研究表明，西洛他唑可改善氯吡格雷的反应性。我们研究了在阿司匹林加氯吡格雷双联抗血小板治疗的基础上加用西洛他唑的三联抗血小板治疗是否可以预防 Y 型支架内血栓栓塞事件。
2010 年 7 月至 2012 年 10 月，我们使用 Enterprise 支架对 40 例连续动脉瘤进行了弹簧圈栓塞治疗。在围手术期，单支架组（n=36）使用双联抗血小板药物（100mg 阿司匹林和 75mg 氯吡格雷），Y 型支架组（n=4）使用三联抗血小板药物（加用 200mg 西洛他唑）。我们评估了术后弥散加权成像（DWI）和任何并发症。我们进行了统计学分析，分析因素包括年龄、性别、动脉瘤位置、形状和大小、瘤颈大小、载瘤动脉大小和支架长度。
我们发现了两个围手术期的神经并发症：一个短暂性脑缺血发作和一个脑梗死。这两个并发症都属于 Y 型支架组，是血栓栓塞事件的显著因素（P=0.008）。没有其他与神经并发症或阳性 DWI 相关的显著因素。在单支架组的亚组分析中，阳性 DWI 的支架长度明显长于阴性 DWI（P=0.04）。在 20±8.6 个月的随访期间，任何患者均无症状性晚期并发症。
尽管 Y 型支架组的患者数量较少，但该组发生血栓栓塞并发症的风险明显较高。虽然我们的单支架治疗常规双联抗血小板治疗方案可能足够，但我们的 Y 型支架常规三联抗血小板治疗方案可能无法预防血栓栓塞事件。这表明评估血小板功能可能很重要，尤其是对于 Y 型支架。
