Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany.
J Neurointerv Surg. 2020 Sep;12(9):862-868. doi: 10.1136/neurintsurg-2019-015746. Epub 2020 Feb 26.
Coil occlusion has become the standard treatment for many ruptured aneurysms. However, specific aneurysm structures pose technical difficulties and may require the use of adjunctive neck-bridging devices, which necessitate the use of dual antiplatelet therapy. The hydrophilic polymer coating (pHPC, phenox) is a surface modification that inhibits platelet adhesion.
To present initial experience with the pCONUS HPC device as an adjunct to coil embolization for ruptured aneurysms using single antiplatelet therapy (SAPT).
All patients who were treated with the pCONUS HPC for ruptured aneurysms using SAPT were retrospectively identified. The occurrence of thromboembolic and hemorrhagic complications was recorded together with the angiographic and clinical follow-up details.
Fifteen patients were identified (nine female) with a median age of 54 years (range 27-81). Six aneurysms were located at the anterior communicating artery, five at the middle cerebral artery bifurcation, two at the basilar artery bifurcation, one at the posterior communicating artery, and one involving the intradural internal carotid artery. Ten patients (66.6%) achieved modified Raymond-Roy classification I or II at post-treatment angiography, with 45.5% of patients having adequate occlusion (defined as complete occlusion or neck remnant) at follow-up. All patients received acetylsalicylic acid (ASA) as SAPT before and after the procedure. Intraprocedural thrombus formation was seen in three patients (20%), resolving in two patients after a bolus dose of eptifibatide, and one treated with mechanical aspiration. No clinical or radiological consequences were seen. There were no recurrent aneurysm ruptures. One patient died owing to cerebral vasospasm.
This initial clinical experience highlights the possibility and limitations of using the pCONUS HPC device in the treatment of complex ruptured aneurysm with ASA as SAPT. Randomized trials with longer follow-up in larger cohorts are underway.
线圈闭塞已成为治疗许多破裂动脉瘤的标准方法。然而，特定的动脉瘤结构带来了技术上的困难，可能需要使用辅助的颈部桥接装置，这就需要使用双联抗血小板治疗。亲水性聚合物涂层（pHPC，phenox）是一种抑制血小板黏附的表面改性剂。
介绍使用单联抗血小板治疗（SAPT）在破裂动脉瘤的线圈栓塞中附加 pCONUS HPC 装置的初步经验。
回顾性确定了使用 SAPT 用 pCONUS HPC 治疗破裂动脉瘤的所有患者。记录血栓栓塞和出血性并发症的发生情况，以及血管造影和临床随访的详细情况。
确定了 15 例患者（9 例女性），中位年龄为 54 岁（范围 27-81 岁）。6 个动脉瘤位于前交通动脉，5 个位于大脑中动脉分叉处，2 个位于基底动脉分叉处，1 个位于后交通动脉，1 个涉及颅内颈内动脉。10 例患者（66.6%）在治疗后血管造影时达到改良 Raymond-Roy 分级 I 或 II，45.5%的患者在随访时具有足够的闭塞（定义为完全闭塞或残余颈部）。所有患者在治疗前后均接受了乙酰水杨酸（ASA）作为 SAPT。3 例患者（20%）出现术中血栓形成，2 例患者在给予依替巴肽推注剂量后血栓溶解，1 例患者经机械抽吸治疗。未见临床或放射学后果。没有动脉瘤再破裂。1 例患者因脑血管痉挛死亡。
这一初步的临床经验突出了使用 pCONUS HPC 装置在 ASA 作为 SAPT 治疗复杂破裂动脉瘤的可能性和局限性。正在进行更大队列、随访时间更长的随机试验。
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