Rantamo Anni, Gallé Camille, Numminen Jussi, Virta Jyri, Tanskanen Päivi, Lindroos Ann-Christine, Resendiz-Nieves Julio, Lehecka Martin, Niemelä Mika, Haeren Roel, Raj Rahul
Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland.
Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands.
Acta Neurochir (Wien). 2024 Mar 11;166(1):130. doi: 10.1007/s00701-024-06029-7.
The use of antithrombotic medication following acute flow diversion for a ruptured intracranial aneurysm (IA) is challenging with no current guidelines. We investigated the incidence of treatment-related complications and patient outcomes after flow diversion for a ruptured IA before and after the implementation of a standardized antithrombotic medication protocol.
We conducted a single-center retrospective study including consecutive patients treated for acutely ruptured IAs with flow diversion during 2015-2023. We divided the patients into two groups: those treated before the implementation of the protocol (pre-protocol) and those treated after the implementation of the protocol (post-protocol). The primary outcomes were hemorrhagic and ischemic complications. A secondary outcome was clinical outcome using the modified Ranking Scale (mRS).
Totally 39 patients with 40 ruptured IAs were treated with flow diversion (69% pre-protocol, 31% post-protocol). The patient mean age was 55 years, 62% were female, 63% of aneurysms were in the posterior circulation, 92% of aneurysms were non-saccular, and 44% were in poor grade on admission. Treatment differences included the use of glycoprotein IIb/IIIa inhibitors (pre-group 48% vs. post-group 100%), and the use of early dual antiplatelets (pre-group 44% vs. 92% post-group). The incidence of ischemic complications was 37% and 42% and the incidence of hemorrhagic complications was 30% and 33% in the pre- and post-groups, respectively, with no between-group differences. There were three (11%) aneurysm re-ruptures in the pre-group and none in the post-group. There were no differences in mortality or mRS 0-2 between the groups at 6 months.
We found no major differences in the incidence of ischemic or hemorrhagic complications after the implementation of a standardized antithrombotic protocol for acute flow diversion for ruptured IAs. There is an urgent need for more evidence-based guidelines to optimize antithrombotic treatment after flow diversion in the setting of subarachnoid hemorrhage.
对于破裂颅内动脉瘤（IA）急性血流导向术后抗血栓药物的使用颇具挑战，目前尚无相关指南。我们调查了标准化抗血栓药物方案实施前后，破裂IA血流导向术后治疗相关并发症的发生率及患者预后情况。
我们开展了一项单中心回顾性研究，纳入了2015年至2023年期间接受急性破裂IA血流导向治疗的连续患者。我们将患者分为两组：方案实施前治疗的患者（方案前组）和方案实施后治疗的患者（方案后组）。主要结局为出血性和缺血性并发症。次要结局为使用改良Rankin量表（mRS）评估的临床结局。
共有39例患者的40个破裂IA接受了血流导向治疗（方案前组占69%，方案后组占31%）。患者平均年龄为55岁，62%为女性，63%的动脉瘤位于后循环，92%的动脉瘤为非囊状，44%的患者入院时病情较差。治疗差异包括糖蛋白IIb/IIIa抑制剂的使用（方案前组为48%，方案后组为100%），以及早期双联抗血小板药物的使用（方案前组为44%，方案后组为92%）。方案前组和方案后组的缺血性并发症发生率分别为37%和42%，出血性并发症发生率分别为30%和33%，组间无差异。方案前组有3例（11%）动脉瘤再次破裂，方案后组无动脉瘤再次破裂。两组在6个月时的死亡率或mRS 0 - 2评分无差异。
我们发现，对于破裂IA急性血流导向术实施标准化抗血栓方案后，缺血性或出血性并发症的发生率无重大差异。迫切需要更多基于证据的指南，以优化蛛网膜下腔出血情况下血流导向术后的抗血栓治疗。
