Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China.
Department of Interventional Neuroradiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2019 Jul;127:e30-e38. doi: 10.1016/j.wneu.2019.02.007. Epub 2019 Feb 18.
A prospective trial was conducted to investigate the platelet function and association between thrombelastographic (TEG) parameters and embolic or hemorrhagic complications in patients with intracranial aneurysm undergoing stent treatment.
Between September 2013 and June 2016, we prospectively recruited patients with intracranial aneurysm who were treated with stent-assisted coiling. TEG parameters were used to assess the platelet function before stenting procedures. The primary study end point was the onset of ischemic stroke, transient ischemic attack, or silent ischemic events in the territory of the stented artery within 6 months after the procedure. The secondary end point was assessed by bleeding events.
Four hundred and thirty-one patients with 453 intracranial aneurysms were enrolled. A total of 519 neurovascular stents were implanted. During the follow-up, a total of 70 primary end points (16.2%) and 59 secondary end points (13.7%) were detected. Thromboembolic complications such as symptomatic and slient ischemic complications were more frequently observed in patients with large aneurysms (>10 mm, P = 0.01), lower adenosine diphosphate (ADP) inhibition rate (P < 0.0001), and higher ADP-induced platelet-fibrin clot strength (maximum amplitude of adenosine diphosphate [MA-ADP]) (P < 0.0001). Besides, based on multivariate analysis, a higher ADP inhibition ratio was identified as a significant independent predictor of subsequent bleeding events (P < 0.0001). According to the receiver operating characteristic curve analysis, the safe range of the ADP inhibition ratio and MA-ADP of the TEG analysis were identified as 29.45%-55.4% and <46.15, respectively.
The ADP inhibition ratio and MA-ADP of TEG analysis were associated with subsequent cerebral ischemic events and intracranial or extracranial bleeding events in patients with intracranial aneurysm after stent treatment.
一项前瞻性试验旨在研究颅内动脉瘤支架治疗患者的血小板功能与血栓弹力图（TEG）参数之间的关系，以及与栓塞或出血并发症的关系。
2013 年 9 月至 2016 年 6 月，我们前瞻性招募了接受支架辅助弹簧圈治疗的颅内动脉瘤患者。在支架置入术前，使用 TEG 参数评估血小板功能。主要研究终点是支架置入术后 6 个月内被支架治疗动脉供血区发生缺血性卒、短暂性脑缺血发作或无症状性缺血事件。次要终点是出血事件评估。
共纳入 431 例患者（453 个颅内动脉瘤），共植入 519 个神经血管支架。在随访期间，共发现 70 个主要终点（16.2%）和 59 个次要终点（13.7%）。在大动脉瘤（>10mm，P=0.01）、较低的二磷酸腺苷（ADP）抑制率（P<0.0001）和较高的 ADP 诱导血小板-纤维蛋白凝块强度（最大 ADP 振幅[MA-ADP]）（P<0.0001）的患者中，更常观察到血栓栓塞性并发症，如症状性和无症状性缺血性并发症。此外，基于多变量分析，较高的 ADP 抑制率被确定为随后出血事件的显著独立预测因子（P<0.0001）。根据受试者工作特征曲线分析，TEG 分析的 ADP 抑制率和 MA-ADP 的安全范围分别确定为 29.45%-55.4%和<46.15。
TEG 分析的 ADP 抑制率和 MA-ADP 与颅内动脉瘤支架治疗后患者的后续脑缺血事件以及颅内或颅外出血事件相关。
