术前光传输聚集值预测支架辅助线圈栓塞后血栓栓塞并发症。
Preoperative Light Transmission Aggregometry Values Predict for Thromboembolic Complications After Stent-Assisted Coil Embolization.
机构信息
Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan.
Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan.
出版信息
World Neurosurg. 2020 Feb;134:e731-e738. doi: 10.1016/j.wneu.2019.10.179. Epub 2019 Nov 5.
OBJECTIVE
Risk control of thromboembolic complications (TECs) during stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) is crucial for satisfactory treatment outcomes. We retrospectively evaluated the data from our cohort of SACE for UIAs to analyze the role of anatomical, clinical, and stent type-related factors to determine the optimal preoperative values of light transmission aggregometry (LTA) for TEC prevention.
METHODS
From July 2015 to May 2018, we retrospectively analyzed the data from 132 patients with SACE-treated UIAs at our hospital. Data regarding the aneurysm location, maximum diameter, stent type used, preoperative LTA value, and ischemic and hemorrhagic complications were collected. Aspirin 100 mg and clopidogrel 75 mg were started 7 days before surgery, with a "boost" dose (an additional 75 mg of clopidogrel for an LTA value >60%) added after August 2016 to address clopidogrel resistance. After multivariate analysis, we developed our original combined parameter termed the thromboembolic predictor (TEP). Receiver operating characteristic (ROC) analysis for TEP and each significant variable was performed.
RESULTS
TECs were confirmed in 5 of the 132 patients (3.8%) and hemorrhagic complications in 9 of the 132 patients (6.8%). From the multivariate analysis results, the LTA value and maximum diameter were chosen as significant variables and included in the TEP. ROC analysis of the LTA value revealed a sensitivity and specificity of 0.866 and 0.600, respectively (area under the curve, 0.747), with a cutoff of 62%. TEP permitted the establishment of an optimal LTA value according to the aneurysm maximum diameter to predict for TECs. The complication rate for the Neuroform EZ, Enterprise, Neuroform Atlas, and LVIS stents was 2.9%, 10.5%, 1.4%, and 14.3%, respectively.
CONCLUSIONS
The preoperative LTA value contributes to the prediction of TECs after SACE for UIAs. The TEP (relating the LTA cutoff to aneurysm size) allows for improved antiplatelet therapy adjustment before SACE to reduce TECs.
目的
颅内未破裂动脉瘤（UIAs）支架辅助线圈栓塞（SACE）术中血栓栓塞并发症（TECs）的风险控制对于获得满意的治疗效果至关重要。我们回顾性分析了 SACE 治疗 UIAs 患者的队列数据，旨在分析解剖、临床和支架类型相关因素的作用，以确定 TEC 预防的最佳术前光透射聚集计（LTA）值。
方法
我们回顾性分析了 2015 年 7 月至 2018 年 5 月我院 132 例 SACE 治疗 UIAs 患者的数据。收集了动脉瘤位置、最大直径、使用的支架类型、术前 LTA 值以及缺血性和出血性并发症的数据。阿司匹林 100mg 和氯吡格雷 75mg 术前 7 天开始服用，2016 年 8 月后增加“升压”剂量（LTA 值>60%时额外加用 75mg 氯吡格雷）以解决氯吡格雷抵抗问题。多变量分析后，我们开发了一种新的联合参数，即血栓栓塞预测因子（TEP）。对 TEP 和每个显著变量进行了接收者操作特征（ROC）分析。
结果
132 例患者中有 5 例（3.8%）出现 TECs，9 例（6.8%）出现出血性并发症。多变量分析结果表明，LTA 值和最大直径为显著变量，纳入 TEP。LTA 值的 ROC 分析显示敏感性和特异性分别为 0.866 和 0.600（曲线下面积为 0.747），截断值为 62%。TEP 允许根据动脉瘤最大直径确定最佳 LTA 值以预测 TECs。Neuroform EZ、Enterprise、Neuroform Atlas 和 LVIS 支架的并发症发生率分别为 2.9%、10.5%、1.4%和 14.3%。
结论
术前 LTA 值有助于预测 UIAs 支架辅助线圈栓塞术后 TECs。TEP（将 LTA 截断值与动脉瘤大小相关联）可在 SACE 前改善抗血小板治疗的调整，以减少 TECs。
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