Tan Lee A, Keigher Kiffon M, Munich Stephan A, Moftakhar Roham, Lopes Demetrius K
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
J Neurointerv Surg. 2015 Mar;7(3):217-21. doi: 10.1136/neurintsurg-2014-011111. Epub 2014 Feb 19.
Thromboembolic events after Pipeline Embolization Device (PED) placement remain a feared complication among neuroendovascular surgeons. This study aimed to investigate potential risk factors for thromboembolic events in patients undergoing PED placement.
Medical records of patients who underwent PED placement from April 2011 to August 2013 were reviewed. Variables including pre-procedure P2Y12 reaction unit (PRU) value, procedure time, number of PEDs deployed and perioperative neurovascular complications were recorded. Multivariate analysis was performed to identify risk factors for perioperative thromboembolic complications.
Seventy-four patients were identified. Six patients (8.1%) had changes in neurological status after PED placement including five (6.8%) thromboembolic complications and one (1.4%) delayed intracranial hemorrhage; 50.9% of patients had diffusion-weighted imaging (DWI) changes on post-procedural MRI. Longer procedure time (>116 min) and multiple PED placements (>1) were statistically significant risk factors for symptomatic thromboembolic events (p<0.01). A pre-procedural PRU value >208 had an OR of 11.32 (95% CI 0.06 to 212.57) for symptomatic thromboembolic complications, but the result was not statistically significant.
DWI changes on MRI occurred at a much higher rate than new neurological symptoms following PED placement. Longer procedure time and multiple PED deployment are associated with higher risks of new neurological changes due to thromboembolic events. There was a trend for an increased risk of a symptomatic thromboembolic event in patients with pre-procedural PRU values >208. Reloading (clopidogrel 600 mg) patients with preoperative PRU >208 was safe and may have a protective effect on thromboembolic events.
在神经血管内外科医生中，使用管道栓塞装置（PED）后发生血栓栓塞事件仍然是令人担忧的并发症。本研究旨在调查接受PED植入的患者发生血栓栓塞事件的潜在危险因素。
回顾了2011年4月至2013年8月接受PED植入的患者的病历。记录包括术前P2Y12反应单位（PRU）值、手术时间、植入的PED数量和围手术期神经血管并发症等变量。进行多因素分析以确定围手术期血栓栓塞并发症的危险因素。
共纳入74例患者。6例患者（8.1%）在PED植入后出现神经功能状态改变，其中5例（6.8%）发生血栓栓塞并发症，1例（1.4%）发生迟发性颅内出血；50.9%的患者术后MRI弥散加权成像（DWI）有改变。较长的手术时间（>116分钟）和多次植入PED（>1枚）是有症状血栓栓塞事件的统计学显著危险因素（p<0.01）。术前PRU值>208的患者发生有症状血栓栓塞并发症的OR为11.32（95%CI 0.06至212.57），但结果无统计学意义。
PED植入后MRI上DWI改变的发生率远高于新出现的神经症状。较长的手术时间和多次植入PED与因血栓栓塞事件导致新的神经功能改变的较高风险相关。术前PRU值>208的患者有症状血栓栓塞事件的风险有增加趋势。对术前PRU>208的患者重新给药（氯吡格雷600mg）是安全的，可能对血栓栓塞事件有保护作用。
