目的 探讨替罗非班在支架置入术治疗颅内动脉瘤中的应用价值.方法 回顾性分析2019年12月至2023年8月聊城市第三人民医院神经介入科行支架置入术治疗的213例颅内动脉瘤患者的临床资料,共219个动脉瘤.其中,207例患者采用支架辅助弹簧圈栓塞,4例置入Willis覆膜支架,2例置入Pipeline支架治疗.所有患者在术中置入支架后,均通过中间导管给予小剂量替罗非班,同时静脉持续泵入替罗非班.术后即刻复查数字减影血管造影,以观察动脉瘤的栓塞情况、靶血管的通畅程度,以及有无脑梗死或脑出血,并记录围手术期手术并发症.采用Pipeline支架置入治疗的动脉瘤以O'Kelly-Marotta(OKM)分级评估即刻闭塞程度,其余动脉瘤采用Raymond分级评估.采用改良Rankin量表评分(mRS)评估患者术后90 d的预后,通过影像学评估随访期间有无动脉瘤复发.结果 219个动脉瘤共置入213枚支架,均准确定位释放,技术成功率为100％.5个动脉瘤采用Pipeline支架栓塞,其术后即刻OKM分级均为B级;其余214个动脉瘤中,Raymond分级为Ⅰ级(完全栓塞)138个(64.5％),Ⅱ级(次全栓塞)39个(18.2％),Ⅲ级(不完全栓塞)37个(17.3％).213例患者中,发生症状性脑出血者3例(1.4％),其中死亡1例,另2例术后90 d mRS分别为0、1分.出现支架内血栓形成继发脑梗死者7例(3.3％),其中1例死亡,其余6例术后90 d mRS为0～2分.术后90d,预后良好(mRS为0～2分)202例(94.8％),预后不良(mRS为3～6分)11例(5.2％).术后6个月,98个动脉瘤完成影像学随访,动脉瘤的复发比例为3.1％(3/98).结论 在支架置入术治疗颅内动脉瘤的手术中,通过动脉给予小剂量替罗非班并静脉持续给药的安全性较好,其发生支架内血栓形成和症状性脑出血的比率较低,患者的预后满意.
Application value of tirofiban in stent implantation of intracranial aneurysms
Objective To investigate the application value of tirofiban in patients with intracranial aneurysms treated by stent implantation.Methods A retrospective analysis was performed on 213 patients who underwent stent treatment of 219 intracranial aneurysms at the Department of Interventional Neurology,Liaocheng Third People's Hospital from December 2019 to August 2023.Among them,207 cases were treated with stent-assisted coil embolization,4 cases were treated with Willis covered stents,and 2 cases were treated with Pipeline stents.After intraoperative stent placement,all patients were given low-dose tirofiban through the intermediate catheter,while tirofiban was continuously pumped intravenously.Digital subtraction angiography(DSA)was reviewed immediately after surgery to observe the embolization of the aneurysm,the patency of the target blood vessel,and whether there was cerebral infarction or cerebral hemorrhage,and perioperative surgical complications were recorded.Aneurysms treated with Pipeline stent implantation were evaluated with the O'Kelly-Marotta(OKM)grade for immediate occlusion,and other aneurysms were evaluated with the Raymond grade.The modified Rankin scale(mRS)was used to evaluate the patient's prognosis 90 days after surgery,and imaging was used to evaluate whether aneurysm recurrence during the follow-up period was present.Results A total of 213 stents were placed in 219 aneurysms,all of which were accurately positioned and released,with a technical success rate of 100％.Five aneurysms were embolized with Pipeline stent,and their OKM classification was all grade B.Among the remaining 214 aneurysms,138(64.5％)were graded Raymond grade Ⅰ(complete embolization),and 39(18.2％)were grade Ⅱ(subtotal embolization),and 37 cases(17.3％)were grade Ⅲ(incomplete embolization).Among the 213 patients,3 cases(1.4％)developed symptomatic cerebral hemorrhage,of which 1 case died,and the other 2 cases had follow-up mRS of 0 and 1 points respectively 90 days after surgery.Cerebral infarction secondary to stent thrombosis occurred in 7 cases(3.3％),of which 1 died and the remaining 6 cases had mRS of 0 to 2 points at 90-day follow-up.At 90 days after surgery,202 cases(94.8％)had a good outcome(mRS of 0 to 2 points)and 11 cases(5.2％)had a poor outcome(mRS of 3 to 6 points).At 6 months after surgery,imaging follow-up was conducted for 98 aneurysms,and the recurrence rate of aneurysms was 3.1％(3/98).Conclusions In stent placement surgery to treat intracranial aneurysms,low-dose tirofiban administered through the artery and continuously administered intravenously is safe.The rates of in-stent thrombosis and symptomatic cerebral hemorrhage are low,leading to satisfactory outcomes.
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