Gentric Jean-Christophe, Brisson Joelle, Batista André Lima, Ghostine Jimmy, Raymond Jean, Roy Daniel, Weill Alain
CHUM Montréal, Neuroradiology, Montréal, Québec, Canada.
CHUM Montréal, Neuroradiology, Montréal, Québec, Canada
Interv Neuroradiol. 2015 Jun;21(3):332-6. doi: 10.1177/1591019915582001. Epub 2015 May 11.
We aimed to determine the safety of intra-arterial Abciximab injection in the management of thromboembolic complications during endovascular treatment of ruptured cerebral aneurysms.
In a monocentric consecutive series of endovascular treatment of 783 ruptured aneurysms, 42 (5.3%) patients received Abciximab after the aneurysm was secured. Bleeding complications were registered and dichotomized as follows: new intracranial hemorrhage and peripheral bleeding. For each patient, World Federation of Neurosurgery (WFNS) subarachnoid hemorrhage (SAH) grade, shunting, and clinical outcomes in the post-operative period and at 3-6 months were recorded.
SAH WFNS grades were as follows: grade I n = 14, grade II n = 10, grade III n = 11, grade IV n = 4, grade V n = 3. Ten patients had intracranial hematoma additionally to the SAH prior to embolization. Four patients (9.5%) presented more blood on the post-embolization CT but only one suffered a new clinically relevant intracranial hemorrhage. Two patients (4.8%) experienced significant peripheral bleeding but none were associated with long-term disabilities. Fourteen patients had a shunt installed less than 24 h prior to Abciximab injection and one less than 48 h later. At 3-6-month follow-up, 31 patients (74%) achieved a modified Rankin Scale score (mRS) of 2 or less, six patients (14%) had a mRS of 3-5, three were dead (7%), and two were lost at follow-up.
When the aneurysm is secured, intra-arterial Abciximab injection is a low complication rate treatment modality for thromboembolic events during embolization of cerebral ruptured aneurysm.
我们旨在确定动脉内注射阿昔单抗在破裂脑动脉瘤血管内治疗期间血栓栓塞并发症管理中的安全性。
在一个单中心连续系列研究中，对783例破裂动脉瘤进行血管内治疗，42例（5.3%）患者在动脉瘤固定后接受了阿昔单抗治疗。记录出血并发症并分为以下两类：新的颅内出血和外周出血。记录每位患者的世界神经外科联合会（WFNS）蛛网膜下腔出血（SAH）分级、分流情况以及术后和3至6个月时的临床结局。
SAH的WFNS分级如下：I级n = 14例，II级n = 10例，III级n = 11例，IV级n = 4例，V级n = 3例。10例患者在栓塞前除SAH外还存在颅内血肿。4例（9.5%）患者在栓塞后CT上显示出血增多，但只有1例发生了新的具有临床意义的颅内出血。2例（4.8%）患者出现明显的外周出血，但均未导致长期残疾。14例患者在注射阿昔单抗前不到24小时安装了分流装置，1例在注射后不到48小时安装。在3至6个月的随访中，31例患者（74%）改良Rankin量表评分（mRS）为2或更低，6例患者（14%）mRS为3至5，3例死亡（7%），2例失访。
当动脉瘤固定后，动脉内注射阿昔单抗是脑破裂动脉瘤栓塞期间血栓栓塞事件并发症发生率较低的治疗方式。
