Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China.
Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China
J Neurointerv Surg. 2021 Sep;13(9):835-840. doi: 10.1136/neurintsurg-2020-016878. Epub 2020 Nov 16.
Flow diverter (FD) is widely used in the treatment of intracranial aneurysms. However, thromboembolic events (TEs) continue to be the major complications during the periprocedural phase. To evaluate the safety and efficacy of the prophylactic use of tirofiban, combined with the conventional dual antiplatelet therapy (DAT), as a new antiplatelet protocol in patients with intracranial aneurysms treated with FDs.
At least 3-5 days before the procedure, daily DAT were administrated to the patients. Tirofiban was administered as an intravenous bolus (5 µg/kg) over a 3 min period during or immediately after FD deployment, followed by a 0.05 µg/kg/min maintenance infusion for 24-48 hours. Periprocedural TEs and hemorrhagic events (HEs) were recorded.
A total of 331 patients were included, including 229 (69.2%) who received tirofiban administration (tirofiban group) and 102 (30.8%) who received only DAT (non-tirofiban group). Periprocedural TEs occurred in 12 (3.6%) patients, including eight (7.8%) in the non-tirofiban group and four (1.7%) in the tirofiban group. In multivariate analysis, patients receiving tirofiban administration had significantly lower TEs as compared with those who received only DAT (P=0.004). Balloon angioplasty and longer procedure time (>137 min) were also risk factors for TEs. Also, no increase was observed in the rate of HEs related to tirofiban administration.
The current study suggested that prophylactic administration of tirofiban combined with conventional oral DAT seems safe and efficient for preventing TEs during FD treatment of unruptured intracranial aneurysms. Balloon angioplasty and prolonged procedure are associated with a high risk of TEs.
血流导向装置（FD）广泛应用于颅内动脉瘤的治疗。然而，围手术期仍存在血栓栓塞事件（TEs）这一主要并发症。本研究旨在评估替罗非班联合常规双联抗血小板治疗（DAT）作为一种新的抗血小板方案，用于颅内动脉瘤患者接受 FD 治疗的安全性和有效性。
患者至少在术前 3-5 天开始接受每日 DAT 治疗。在 FD 置入术中或术后即刻，替罗非班以静脉推注（5μg/kg）的方式给药，持续 3 分钟，继以 0.05μg/kg/min 的维持滴注 24-48 小时。记录围手术期 TEs 和出血事件（HEs）。
共纳入 331 例患者，其中 229 例（69.2%）接受替罗非班给药（替罗非班组），102 例（30.8%）仅接受 DAT 治疗（非替罗非班组）。12 例（3.6%）患者发生围手术期 TEs，其中非替罗非班组 8 例（7.8%），替罗非班组 4 例（1.7%）。多变量分析显示，与仅接受 DAT 治疗的患者相比，接受替罗非班给药的患者 TEs 发生率显著降低（P=0.004）。球囊血管成形术和较长的手术时间（>137 分钟）也是 TEs 的危险因素。此外，替罗非班给药并未增加与 HE 相关的发生率。
本研究表明，替罗非班联合常规口服 DAT 预防未破裂颅内动脉瘤 FD 治疗期间 TEs 的发生是安全有效的。球囊血管成形术和手术时间延长与 TEs 的高风险相关。
