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目的评价替罗非班在支架辅助栓塞治疗颅内动脉瘤时的效果和安全性。方法 2010年1月—2011年12月,采用支架辅助弹簧圈栓塞或单纯行载瘤动脉内支架置入治疗颅内宽颈动脉瘤42例(46个动脉瘤)。在成功置入支架后,应用替罗非班(8～10μg/kg,静脉推注,3～5 min,继而以0.1～0.15μg.kg-1.min-1持续泵入24 h,然后降为0.05～0.07μg.kg-1.min-1,持续泵入24～48 h)行抗血小板聚集治疗。术后次日逐渐过渡到常规剂量口服阿司匹林和氯吡格雷。对其临床资料进行回顾性分析。结果①46个动脉瘤中,破裂动脉瘤18个,未破裂动脉瘤28个;在支架辅助下用弹簧圈栓塞40个,单纯行载瘤动脉内支架置入6个。术中出现支架内血栓形成3例,均经导引导管动脉内注射替罗非班(150～250μg,3～5 min)后恢复再通;术中微导丝穿破动脉瘤1个,为次全栓塞动脉瘤,术后患者苏醒,但2h后突发脑疝死亡。②本组34例患者血小板计数在术前、术后3 d的平均值分别为(150±53)×109/L和(142±43)×109/L(t=1.738,P=0.092);部分活化凝血酶时间(APTT)在术前、术后3 d的平均值分别为(25±6)s和(26±4)s(t=-1.087,P=0.285),差异均无统计学意义。有41例患者在术后48～72 h成功过渡到口服抗血小板聚集药物。在应用替罗非班期间无出血并发症、出血倾向及脑血栓、短暂性脑缺血发作等。结论选择性使用替罗非班,对支架辅助栓塞颅内动脉瘤的患者,较为便捷、有效;但对动脉瘤出血急性期患者应用时需慎重,其安全性有待进一步观察。
Objective To evaluate the efficacy and safety of tirofiban in the treatment of intracranial aneurysms with stent-assisted embolization. Methods From January 2010 to December 2011, 42 cases of intracranial wide-necked aneurysms (46 aneurysms) were treated with stent-assisted coil embolization or single parental stent-graft. After successful placement of the stent, tirofiban (8-10 μg / kg, iv bolus 3 to 5 min, followed by continuous infusion of 0.1 to 0.15 μg.kg-1 .min-1 for 24 h and then 0.05 ~ 0.07μg.kg-1.min-1, continued to pump 24 ~ 48h) anti-platelet aggregation therapy. The next day after the gradual transition to the conventional dose of oral aspirin and clopidogrel. The clinical data were retrospectively analyzed. Results ① Among the 46 aneurysms, 18 aneurysms were ruptured and 28 were unruptured aneurysms. Forty-four aneurysms were embolized with coils with the help of stents. Six of them were implanted with stent-grafts alone. Intraoperative stent thrombosis occurred in 3 cases, were guided intra-arterial catheterization of tirofiban after catheterization (150 ~ 250μg, 3 ~ 5 min) and then recanalization; intraoperative micro-guide wire to wear aneurysm was Subtotal embolism aneurysms, patients recovered after surgery, but after 2h sudden hernia death. ② The platelet count of 34 patients in this group was (150 ± 53) × 109 / L and (142 ± 43) × 109 / L, respectively, preoperatively and 3 days after operation (t = 1.738, P = 0.092) The preoperative and postoperative 3 days mean partial thromboplastin time (APTT) were (25 ± 6) s and (26 ± 4) s (t = -1.087, P = 0.285, respectively) significance. 41 patients successfully transition to oral anti-platelet aggregation drug 48 ~ 72 h after surgery. In the application of tirofiban no bleeding complications, bleeding tendency and cerebral thrombosis, transient ischemic attack and so on. Conclusion The selective use of tirofiban in patients with stent-assisted embolization of intracranial aneurysms, more convenient and effective; but acute aneurysm bleeding patients need to be cautious, its safety remains to be further observed.