Raychev Radoslav, Tateshima Satoshi, Vinuela Fernando, Sayre Jim, Jahan Reza, Gonzalez Nestor, Szeder Viktor, Duckwiler Gary
UCLA, Los Angeles, CA, USA
UCLA, Los Angeles, CA, USA.
Interv Neuroradiol. 2016 Feb;22(1):34-41. doi: 10.1177/1591019915609125. Epub 2015 Nov 3.
The mechanisms leading to delayed rupture, distal emboli and intraparenchymal hemorrhage in relation to pipeline embolization device (PED) placement remain debatable and poorly understood. The aim of this study was to identify clinical and procedural predictors of these perioperative complications.
We conducted a retrospective review of consecutive patients who underwent PED placement. We utilized a non-commercial platelet aggregation method measuring adenosine diphosphate (ADP)% inhibition for evaluation of clopidogrel response. To our knowledge, this is the first study to test ADP in neurovascular procedures. Multivariable regression analysis was used to identify the strongest predictor of three separate outcomes: (1) thrombotic complications, (2) hemorrhagic complications, and (3) aneurysm mass effect exacerbation
Permanent complication-related morbidity and mortality at 3 months was 6% (3/48). No specific predictors of hemorrhagic complications were identified. In the univariate analysis, the strongest predictors of thrombotic complications were: ADP% inhibition<49 (p=0.01), aneurysm size (p=0.04) and fluoroscopy time (p=0.002). In the final multivariate analysis, among all baseline variables, fluoroscopy time exceeding 52 min was the only factor associated with thrombotic complications (p=0.007). Aneurysm size≥18 mm was the single predictor of mass effect exacerbation (p=0.039).
Procedural complexity, reflected by fluoroscopy time, is the strongest predictor of thrombotic complications in this study. ADP% inhibition is a reliable method of testing clopidogrel response in neurovascular procedures and values of <50% may predict thrombotic complications. Interval mass effect exacerbation after PED placement may be anticipated in large aneurysms exceeding 18 mm.
与管道栓塞装置（PED）置入相关的导致延迟破裂、远端栓塞和脑实质内出血的机制仍存在争议且了解甚少。本研究的目的是确定这些围手术期并发症的临床和操作预测因素。
我们对连续接受PED置入的患者进行了回顾性研究。我们采用一种非商业性血小板聚集方法，通过测量二磷酸腺苷（ADP）%抑制率来评估氯吡格雷反应。据我们所知，这是第一项在神经血管手术中检测ADP的研究。多变量回归分析用于确定三个不同结果的最强预测因素：（1）血栓形成并发症，（2）出血并发症，以及（3）动脉瘤占位效应加重。
3个月时永久性并发症相关的发病率和死亡率为6%（3/48）。未发现出血并发症的特定预测因素。在单变量分析中，血栓形成并发症的最强预测因素为：ADP%抑制率<49（p=0.01）、动脉瘤大小（p=0.04）和透视时间（p=0.002）。在最终的多变量分析中，在所有基线变量中，透视时间超过52分钟是与血栓形成并发症相关的唯一因素（p=0.007）。动脉瘤大小≥18mm是占位效应加重的唯一预测因素（p=0.039）。
透视时间所反映的操作复杂性是本研究中血栓形成并发症的最强预测因素。ADP%抑制率是在神经血管手术中检测氯吡格雷反应的可靠方法，<50%的值可能预测血栓形成并发症。对于超过18mm的大型动脉瘤，可预期PED置入后会出现间歇性占位效应加重。
