Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany.
Department of Neurology, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany.
Clin Neuroradiol. 2023 Jun;33(2):343-351. doi: 10.1007/s00062-022-01214-6. Epub 2022 Sep 6.
Acute intraprocedural thrombosis (AIT) is a severe complication of flow diverter stent (FDS) implantation for the treatment of intracranial aneurysms. Even though device-related thromboembolic complications are well known, there are no acknowledged risk factors nor defined surveillance protocols for their early detection. This study aimed to demonstrate that an angiographic active surveillance is effective to detect and treat AIT. Furthermore, we investigated risk factors for the occurrence of AIT.
A prospective institutional protocol consisting of a defined observation period of 30 min following FDS deployment was established to detect AIT. Overall incidence, as well as the efficacy and safety of AIT treatment were assessed. Moreover, radiological and clinical outcomes of patients with AIT were analyzed. The influence of various patient- and procedure-related factors on the occurrence of AIT was investigated using multivariable forward logistic regression.
During active surveillance twelve cases of AIT were observed among a total of 161 procedures (incidence: 7.5%). The median time of first observation was 15.5 min (IQR 9.5) after FDS implantation. The early recognition of AIT ensured a prompt treatment with intravenous application of a glycoprotein IIb/IIIa inhibitor, which led to complete thrombus resolution in all cases without hemorrhagic complications. Patients with pre-existing arterial hypertension and side branches originating from the aneurysmal sac had a higher risk of AIT (respectively OR, 9.844; OR, 3.553). There were two cases of re-thrombosis in the short-term postoperative period, of whom one died. The remaining patients with AIT had a good clinical outcome.
Active surveillance for 30 min after FDS implantation is an effective strategy for early detection and ensuing treatment of AIT and can thus prevent secondary sequalae. Hypertension and side branches originating from the aneurysmal sac may increase the risk of AIT.
急性术中血栓形成（AIT）是血流导向支架（FDS）植入治疗颅内动脉瘤的严重并发症。尽管器械相关的血栓栓塞并发症众所周知，但对于其早期检测尚无公认的危险因素或明确的监测方案。本研究旨在证明血管造影主动监测可有效检测和治疗 AIT。此外，我们还研究了 AIT 发生的危险因素。
建立了一项前瞻性的机构方案，在 FDS 植入后设定了 30 分钟的明确观察期，以检测 AIT。评估了 AIT 的总发生率、疗效和安全性。此外，还分析了 AIT 患者的放射学和临床结局。使用多变量向前逻辑回归研究了各种患者和手术相关因素对 AIT 发生的影响。
在主动监测期间，在总共 161 例手术中观察到 12 例 AIT（发生率：7.5%）。首次观察的中位数时间为 FDS 植入后 15.5 分钟（IQR 9.5）。早期识别 AIT 确保了及时应用糖蛋白 IIb/IIIa 抑制剂进行治疗，所有病例的血栓均完全溶解，无出血并发症。患有先前存在的动脉高血压和起源于动脉瘤囊的侧支的患者 AIT 风险较高（分别 OR，9.844；OR，3.553）。术后短期内有 2 例再血栓形成，其中 1 例死亡。其余 AIT 患者的临床结局良好。
在 FDS 植入后 30 分钟进行主动监测是早期发现和随后治疗 AIT 的有效策略，可预防继发性后遗症。高血压和起源于动脉瘤囊的侧支可能会增加 AIT 的风险。
