Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, University of California, Irvine School of Medicine, Orange, California, USA.
Stroke Vasc Neurol. 2018 Apr 21;3(3):169-175. doi: 10.1136/svn-2018-000150. eCollection 2018 Sep.
Acute in situ thrombosis is an ischaemic phenomenon during Pipeline embolisation device (PED) procedures with potentially high morbidity and mortality. There is controversy regarding the role of platelet function testing with P2Y12 assay as a predictor of intraprocedural thromboembolic events. There is limited knowledge on whether procedural complexity influences these events.
Data were collected retrospectively on 742 consecutive PED cases at a single institution. Patients with intraprocedural acute thrombosis were compared with patients without these events.
A cohort of 37 PED cases with acute in situ thrombosis (mean age 53.8 years, mean aneurysm size 8.4 mm) was matched with a cohort of 705 PED cases without intraprocedural thromboembolic events (mean age 56.4 years, mean aneurysm size 6.9 mm). All patients with in situ thrombosis received intra-arterial and/or intravenous abciximab. The two groups were evenly matched in patient demographics, previous treatment/subarachnoid hemorrhage (SAH) and aneurysm location. There was no statistical difference in postprocedural P2Y12 reaction unit (PRU) values between the two groups, with a mean of 156 in the in situ thrombosis group vs 148 in the control group (p=0.5894). Presence of cervical carotid tortuosity, high cavernous internal carotid artery grade, need for multiple PED and vasospasm were not significantly different between the two groups. The in situ thrombosis group had statistically significant longer fluoroscopy time (60.4 vs 38.4 min, p<0.0001), higher radiation exposure (3476 vs 2160 mGy, p<0.0001), higher rates of adjunctive coiling (24.3% vs 8.37%, p=0.0010) and higher utilisation of balloon angioplasty (37.8% vs 12.2%, p<0.0001). Clinically, the in situ thrombosis cohort had higher incidence of major and minor stroke, intracerebral haemorrhage and length of stay.
Predictors of procedural complexity (higher radiation exposure, longer fluoroscopy time, adjunctive coiling and need for balloon angioplasty) are associated with acute thrombotic events during PED placement, independent of PRU values.
在 Pipeline 栓塞装置（PED）手术中，急性原位血栓形成是一种缺血现象，具有较高的发病率和死亡率。血小板功能检测，特别是 P2Y12 检测，作为术中血栓栓塞事件的预测指标，存在争议。关于手术复杂性是否会影响这些事件，目前的认识有限。
在一家医疗机构回顾性收集了 742 例连续的 PED 病例数据。将术中发生急性血栓形成的患者与无这些事件的患者进行比较。
在 37 例发生急性原位血栓形成的 PED 病例（平均年龄 53.8 岁，平均动脉瘤大小 8.4mm）中，匹配了 705 例无术中血栓栓塞事件的 PED 病例（平均年龄 56.4 岁，平均动脉瘤大小 6.9mm）。所有原位血栓形成的患者均接受了动脉内和/或静脉内阿昔单抗治疗。两组患者的人口统计学、既往治疗/蛛网膜下腔出血（SAH）和动脉瘤位置均匹配良好。两组患者术后 P2Y12 反应单位（PRU）值无统计学差异，原位血栓形成组平均为 156，对照组平均为 148（p=0.5894）。两组患者的颈内动脉迂曲、海绵窦内颈内动脉分级高、需要多个 PED 和血管痉挛的发生率无显著差异。原位血栓形成组的透视时间（60.4 分钟 vs 38.4 分钟，p<0.0001）、辐射暴露量（3476 毫戈瑞 vs 2160 毫戈瑞，p<0.0001）、辅助弹簧圈栓塞的发生率（24.3% vs 8.37%，p=0.0010）和球囊血管成形术的使用率（37.8% vs 12.2%，p<0.0001）均显著较高。在临床方面，原位血栓形成组的主要和次要中风、颅内出血和住院时间发生率较高。
与 PRU 值无关，与手术复杂性相关的预测因素（更高的辐射暴露、更长的透视时间、辅助弹簧圈栓塞和需要球囊血管成形术）与 PED 放置过程中的急性血栓形成事件相关。
