Li Li, Huang Qing-Hai, Shao Qiu-Ji, Chang Kai-Tao, Zhang Qian-Qian, Zhu Liang-Fu, Liu Jian-Min, Li Tian-Xiao, Gao Bu-Lang
Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan Province, China.
Cerebrovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China.
Sci Rep. 2024 Dec 5;14(1):30331. doi: 10.1038/s41598-024-81792-2.
To investigate the safety, efficacy and risk factors for complications of stenting with optional coiling versus coiling alone for acutely ruptured cerebral aneurysms (ARCAs) using different antiplatelet schemes, 2021 patients were prospectively enrolled into the stenting group (n = 967) and the coiling group (n = 1054). Four different antiplatelet regimens were used. The clinical and treatment data were analyzed and compared. In the stenting group, the common antiplatelet regimen was applied in 259 patients (26.8%), loading regimen in 210 (21.7%), intravenous tirofiban regimen in 240 (24.8%), and premedication free regimen in 258 (26.7%). The aneurysm occlusion degrees in the coiling vs. stenting group were not significantly (P > 0.05) different after treatment. Complications occurred in 168 (15.94%) and 171 (17.68%) patients in the coiling and the stenting group, respectively. Fifteen (1.55%) patients experienced stent-related ischemic complications. The only significant (P < 0.05) independent protective factor for complete occlusion was stent-assisted coiling in the stenting group but aneurysm daughter sac in the coiling group. Significant (P < 0.05) independent risk factors for poor mRS (3-6) were posterior circulation aneurysms and neurological bleeding complications in the stenting group and neurological complications in the coiling group. In the stenting group, the only independent risk factor was parent artery stenosis for neurological complications, Raymond grade III for neurological ischemic complications, and the ice cream technique for total complications in the stenting group. In conclusion, different antiplatelet schemes can be safely and efficiently used for intracranial stenting with optional coiling as compared with coiling alone for ARCAs.
为了研究使用不同抗血小板方案，对急性破裂脑动脉瘤（ARCA）进行选择性弹簧圈栓塞联合支架置入术与单纯弹簧圈栓塞术的安全性、有效性及并发症风险因素，前瞻性纳入2021例患者，分为支架置入组（n = 967）和弹簧圈栓塞组（n = 1054）。采用四种不同的抗血小板治疗方案。对临床和治疗数据进行分析和比较。在支架置入组中，259例患者（26.8%）采用常规抗血小板方案，210例（21.7%）采用负荷方案，240例（24.8%）采用静脉替罗非班方案，258例（26.7%）采用无预处理方案。治疗后，弹簧圈栓塞组与支架置入组的动脉瘤闭塞程度差异无统计学意义（P > 0.05）。弹簧圈栓塞组和支架置入组分别有168例（15.94%）和171例（17.68%）患者发生并发症。15例（1.55%）患者出现与支架相关的缺血性并发症。支架置入组中，完全闭塞的唯一显著（P < 0.05）独立保护因素是支架辅助弹簧圈栓塞，而弹簧圈栓塞组是动脉瘤子囊。支架置入组中改良Rankin量表（mRS）评分3 - 6分的显著（P < 0.05）独立危险因素是后循环动脉瘤和神经出血并发症，弹簧圈栓塞组是神经并发症。在支架置入组中，神经并发症的唯一独立危险因素是载瘤动脉狭窄，神经缺血性并发症是Raymond III级，总体并发症是“冰淇淋”技术。总之，与单纯弹簧圈栓塞术相比，不同抗血小板方案可安全有效地用于ARCA的选择性弹簧圈栓塞联合颅内支架置入术。
