Hôpital Erasme, Université Libre de Bruxelles (ULB), 808, Route de Lennik, 1070, Brussels, Belgium.
Service de la Recherche Biomédicale, Université Libre de Bruxelles (ULB), 808, Route de Lennik, 1070, Brussels, Belgium.
Neuroradiology. 2020 Aug;62(8):1029-1041. doi: 10.1007/s00234-020-02387-y. Epub 2020 Mar 13.
Endovascular treatment of unruptured intracranial aneurysms with stent-assisted coiling or flow diverter stents requires a prophylactic antiplatelet premedication to avoid thrombo-embolic complications. Guidelines for optimal antiplatelet regimens are poorly defined. The aim of this study is to report our experience using a high dosage antiplatelet premedication regimen for patients with unruptured intracranial aneurysms undergoing endovascular treatment by stent-assisted coiling or flow diverter stents.
From a retrospective analysis of a prospectively maintained database, we collected clinical and angiographic data of 400 procedures in 362 patients treated by stent-assisted coiling or flow diverter stents for 419 unruptured intracranial aneurysms. Descriptive and analytic statistics were performed to report morbidity, mortality, and complication rates and to demonstrate associations between variables and outcomes. Logistic multivariable regression was performed to rule out confounding factors between subgroups.
Thrombo-embolic complications occurred in 23/400 procedures (5.75%) and hemorrhagic complications in 19/400 procedures (4.75%). The majority of complications were minor and transient with overall procedure-related morbidity and mortality rates of 1.75% (n = 7/400) and 1.25% (n = 5/400) respectively. The co-existence of multiple cardiovascular risk factors among smoking, hypertension, dyslipidemia, and age > 65 years old was significantly associated with permanent procedure-related morbidity (p = 0.006) and thrombo-embolic complications occurrence (p = 0.034). Age alone was associated with higher permanent morbidity (p = 0.029) and was the only variable associated with higher hemorrhagic complication (p = 0.024).
In this study, the use of a high dosage antiplatelet premedication was safe and effective for the treatment of unruptured intracranial aneurysms with stent-assisted coiling or flow diverter stents. Mortality and morbidity rates compare favorably with the current literature. The thrombo-embolic complications rate is low and most of them were clinically silent. However, the hemorrhagic complications rate was substantial and a significant proportion of them were associated with mortality.
血管内治疗未破裂颅内动脉瘤需要支架辅助弹簧圈或血流导向支架治疗，以避免血栓栓塞并发症。最佳抗血小板方案的指南定义较差。本研究的目的是报告我们使用高剂量抗血小板预治疗方案治疗接受支架辅助弹簧圈或血流导向支架治疗的未破裂颅内动脉瘤患者的经验。
从前瞻性维护的数据库中进行回顾性分析，我们收集了 362 名患者的 400 例手术的临床和血管造影数据，这些患者因 419 个未破裂颅内动脉瘤接受了支架辅助弹簧圈或血流导向支架治疗。进行描述性和分析性统计以报告发病率、死亡率和并发症发生率，并证明变量与结果之间的关联。进行逻辑多变量回归以排除亚组之间的混杂因素。
23/400 例（5.75%）发生血栓栓塞并发症，19/400 例（4.75%）发生出血性并发症。大多数并发症是轻微和短暂的，整体手术相关发病率和死亡率分别为 1.75%（n=7/400）和 1.25%（n=5/400）。吸烟、高血压、血脂异常和年龄>65 岁等多种心血管危险因素并存与永久性手术相关发病率（p=0.006）和血栓栓塞并发症发生（p=0.034）显著相关。仅年龄与更高的永久性发病率相关（p=0.029），并且是唯一与更高的出血性并发症相关的变量（p=0.024）。
在这项研究中，使用高剂量抗血小板预治疗对于支架辅助弹簧圈或血流导向支架治疗未破裂颅内动脉瘤是安全有效的。死亡率和发病率与当前文献相比有利。血栓栓塞并发症发生率较低，大多数为临床无症状。然而，出血性并发症发生率较高，其中相当一部分与死亡率相关。
