静脉注射替罗非班在急性破裂颅内动脉瘤支架辅助弹簧圈栓塞术中的安全性和有效性：单中心经验。
Safety and efficacy of intravenous tirofiban for stent-assisted coiling in acutely ruptured intracranial aneurysms: A single center experience.
机构信息
Department of Neurosurgery, 89674Zhongnan Hospital of Wuhan University, China.
出版信息
Interv Neuroradiol. 2022 Aug;28(4):476-481. doi: 10.1177/15910199211042463. Epub 2021 Sep 13.
BACKGROUND
There have been few reports on the use of tirofiban in ruptured intracranial aneurysms and the results were conflicting. However, the safety and efficacy of optimal dosage and the reasonable treatment course of tirofiban have not been determined.
OBJECTIVE
To determine the safety and efficacy of a new protocol for its prophylactic tirofiban application during the endovascular treatment of ruptured intracranial aneurysms with no oral antiplatelet medications.
METHODS
This retrospective study was based on 105 patients with ruptured aneurysms who underwent stent-assisted coiling at our institution between August 2017 and July 2020. Intravenous tirofiban was administered to patients after stent deployment. Tirofiban was administered as an intravenous bolus (5 µg/kg) over a 3 min period immediately after stent deployment, followed by a 0.06-0.08 µg/kg/min maintenance infusion for 12-24 h. Dual oral antiplatelet therapy was overlapped with half the tirofiban dose 2 h before the cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded.
RESULTS
This study included a total of 105 patients with ruptured intracranial aneurysms, who underwent stent-assisted coiling. In terms of clinical severity, a presenting Hunt-Hess clinical-grade I was observed in 47 (44.8%) cases, grade II in 19 (18.1%) cases, grade III in 30 (28.6%) cases, grade IV in 6 (5.6%) cases, and grade V in 3 (2.9%) cases. None of the patients showed a newly developed tirofiban-related intracerebral hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, or ventriculostomy-related hemorrhage. There were 3 (2.8%) patients who had thromboembolic complications.
CONCLUSIONS
We have determined a new protocol for prophylactic intraoperative tirofiban during the endovascular treatment of ruptured intracranial aneurysms with no oral antiplatelet medications. In our study, tirofiban showed a low risk of hemorrhagic or thromboembolic complications. Tirofiban appears to be a safe and alternative during the stent-assisted coiling of ruptured intracranial aneurysms.
背景
已有少数关于替罗非班在破裂颅内动脉瘤中应用的报道，但结果相互矛盾。然而，替罗非班的最佳剂量和合理治疗疗程的安全性和有效性尚未确定。
目的
确定一种新的方案，即在血管内治疗破裂颅内动脉瘤时预防性应用替罗非班，且不使用口服抗血小板药物的安全性和有效性。
方法
本回顾性研究基于 2017 年 8 月至 2020 年 7 月在我院接受支架辅助弹簧圈治疗的 105 例破裂动脉瘤患者。支架置入后给予患者静脉替罗非班。支架置入后立即经静脉给予替罗非班 5μg/kg，静脉滴注 3 分钟，然后以 0.06-0.08μg/kg/min 的速度维持滴注 12-24 小时。在停止替罗非班输注前 2 小时，重叠使用双重口服抗血小板治疗，剂量为替罗非班的一半。记录颅内出血或血栓栓塞事件。
结果
本研究共纳入 105 例破裂颅内动脉瘤患者，均接受支架辅助弹簧圈治疗。根据临床严重程度，47 例（44.8%）患者表现为 Hunt-Hess 临床分级 I 级，19 例（18.1%）患者为 II 级，30 例（28.6%）患者为 III 级，6 例（5.6%）患者为 IV 级，3 例（2.9%）患者为 V 级。无一例患者出现新的替罗非班相关性颅内出血、脑室内出血、蛛网膜下腔出血或脑室造口相关出血。有 3 例（2.8%）患者发生血栓栓塞并发症。
结论
我们确定了一种新的方案，即在血管内治疗破裂颅内动脉瘤时预防性应用术中替罗非班，且不使用口服抗血小板药物。在本研究中，替罗非班出血或血栓栓塞并发症风险较低。替罗非班似乎是破裂颅内动脉瘤支架辅助弹簧圈治疗的一种安全且可行的替代药物。
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