Nakahara I, Taki W, Tanaka M, Sadatou A, Matsumoto K, Kikuchi H
Department of Neurosurgery, Faculty of Medicine, Kyoto University, Japan.
Nihon Geka Hokan. 1994 May 1;63(3):91-8.
Endosaccular embolization is an innovative and effective treatment for surgically formidable cerebral aneurysms. Platinum microcoils are soft, easily fit to complex configuration of aneurysms, highly thrombogenic, so that suitable for this purpose. Recently developed Guglielmi detachable coils have more advantages in terms of retrievability and electrothrombotic effect. However, distal migration of intraaneurysmal thrombus produces thromboembolism in normal cerebral arteries, leading to neurological deficits. Three cases are presented in which thromboembolic complications occurred during or after embolization of cerebral aneurysms with platinum microcoils. Emergent fibrinolytic treatment resolved neurological deficits in each case without any other complications. From these lessons, a protocol of intra- and postoperative anticoagulation and antiplatelet therapy is presented. In conclusion, perioperative management of fibrinolytic and coagulation activity is extremely important in preventing thromboembolic complication and obtaining successful result.
囊内栓塞是一种针对手术治疗困难的脑动脉瘤的创新且有效的治疗方法。铂微线圈质地柔软，易于适应动脉瘤的复杂形态，具有高度血栓形成性，因此适用于此目的。最近研发的 Guglielmi 可脱卸线圈在可回收性和电血栓形成效应方面具有更多优势。然而，动脉瘤内血栓的远端迁移会在正常脑动脉中产生血栓栓塞，导致神经功能缺损。本文报告了 3 例在使用铂微线圈栓塞脑动脉瘤期间或之后发生血栓栓塞并发症的病例。紧急溶栓治疗使每例患者的神经功能缺损得到缓解，且无任何其他并发症。从这些经验中，提出了一套术中和术后抗凝及抗血小板治疗方案。总之，围手术期对纤溶和凝血活性的管理对于预防血栓栓塞并发症并取得成功结果极为重要。
