Cinar Celal, Oran Ismail, Ozdemir Halil Ibrahim, Kusbeci Mahmut, Kavakli Ramazan Kaan, Tobu Mahmut, Parildar Zuhal
Department of Interventional Radiology, Ege University Medical School, Izmir, Turkey.
Department of Radiology, Ege University Medical School, Izmir, Turkey.
Interv Neuroradiol. 2024 Aug 8:15910199241272522. doi: 10.1177/15910199241272522.
This study aims to elucidate the early changes in blood biochemistry thrombosis parameters following stent-assisted endovascular treatment of intracranial aneurysms.
Consecutive patients with unruptured aneurysms undergoing stent implantation during endovascular treatment were included in this prospective study with approval from the local ethics committee. Blood samples were collected immediately before and 24 h after the procedure for biochemical analysis, including basic thrombosis indicators, bleeding tests, and a complete blood count.
The study included 80 patients (60 women, 20 men) with 134 aneurysms. A total of 135 stents (110 flow-diverting, 25 standard) were used. Additionally, intrasaccular coiling was utilized in 28 aneurysms among 27 patients. Following the procedure, there was a significant decrease in activated partial thromboplastin time, fibrinogen, hemoglobin, and platelet levels, and a significant increase in prothrombin time, D-dimer, von Willebrand factor (vWF) activity/antigen ratio, and leukocyte levels in all patients. Correlation analyses revealed significant positive associations between platelet and fibrinogen levels, and a negative association between D-dimer and fibrinogen levels in the coil (-) group. Additionally, there was a significant negative correlation between aneurysm volume and vWF activity/antigen ratio, and procedure duration and thrombocyte count, while a positive association was found between aneurysm number and leukocyte count in the coil (-) group.
Analysis of blood chemistry alterations indicates that intravascular thrombosis occurs in the intracranial circulation following stent-assisted endovascular treatment of intracranial aneurysms. This thrombotic process is more pronounced in patients whose aneurysms were left open (i.e. flow-diverting stent alone).
本研究旨在阐明颅内动脉瘤支架辅助血管内治疗后血液生化血栓形成参数的早期变化。
本前瞻性研究纳入了在血管内治疗期间接受支架植入的连续未破裂动脉瘤患者，并获得了当地伦理委员会的批准。在手术前和术后24小时立即采集血样进行生化分析，包括基本血栓形成指标、出血检测和全血细胞计数。
该研究纳入了80例患者（60例女性，20例男性），共134个动脉瘤。总共使用了135个支架（110个血流导向型，25个标准型）。此外，27例患者中的28个动脉瘤采用了瘤内栓塞。手术后，所有患者的活化部分凝血活酶时间、纤维蛋白原、血红蛋白和血小板水平显著降低，而凝血酶原时间、D - 二聚体、血管性血友病因子（vWF）活性/抗原比值和白细胞水平显著升高。相关性分析显示，在单纯栓塞（-）组中，血小板与纤维蛋白原水平之间存在显著正相关，D - 二聚体与纤维蛋白原水平之间存在负相关。此外，在单纯栓塞（-）组中，动脉瘤体积与vWF活性/抗原比值、手术持续时间与血小板计数之间存在显著负相关，而动脉瘤数量与白细胞计数之间存在正相关。
血液化学变化分析表明，颅内动脉瘤支架辅助血管内治疗后颅内循环中发生了血管内血栓形成。这种血栓形成过程在动脉瘤未完全闭塞（即仅使用血流导向型支架）的患者中更为明显。
