[1]蒋业清,鲁 刚,葛 亮,等.颅内动脉瘤介入治疗相关症状性缺血并发症分析[J].介入放射学杂志,2021,30(02):112-117.
　JIANG Yeqing,LU Gang,GE Liang,et al.Intervention-related symptomatic ischemic complications due to endovascular treatment for intracranial aneurysms[J].journal interventional radiology,2021,30(02):112-117.
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颅内动脉瘤介入治疗相关症状性缺血并发症分析()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
30
期数:
2021年02
页码:
112-117
栏目:
神经介入
出版日期:
2021-02-25

文章信息/Info

Title:
Intervention-related symptomatic ischemic complications due to endovascular treatment for intracranial aneurysms
作者:
蒋业清;  鲁 刚;  葛 亮;  黄 磊;  万海林;  王震宇;  潘 婷;  张晓龙
Author(s):
JIANG Yeqing;  LU Gang;  GE Liang;  HUANG Lei;  WAN Hailin;  WANG Zhenyu;  PAN Ting;  ZHANG Xiaolong.
Department of Interventional Radiology， Affiliated Huashan Hospital of Fudan University， Shanghai 200040， China
关键词:
【关键词】 颅内动脉瘤;  血管内治疗;  缺血性并发症
文献标志码:
A
摘要:
【摘要】 目的 探讨颅内动脉瘤介入治疗相关症状性缺血并发症原因和处理措施。方法 回顾性分析2011年1月至2019年4月上海华山医院连续介入治疗的942例患者（1 055枚动脉瘤）中确诊的37例（3.9%，37/942）症状性缺血并发症的原因和处理措施。结果 37例患者中术中症状性缺血并发症25例（2.6%，25/942），包括载瘤动脉内血栓形成16例（瘤颈部反复操作10例、过度栓塞4例、支架贴壁欠佳2例），瘤颈部分支闭塞3例（弹簧圈表面血栓形成或瘤颈部反复操作），远端分支栓塞或血栓形成6例（导引导管内附壁血栓脱落5例、分支血管痉挛1例）；术后症状性缺血并发症12例（1.3%，12/942），包括载瘤动脉内血栓形成7例（替罗非班应用不足3例、支架贴壁欠佳1例、支架串联重叠部位血栓形成1例、弹簧圈致栓1例、重度贫血1例），瘤颈部分支闭塞1例（弹簧圈表面血栓形成），远端分支栓塞或血栓形成4例（均为球囊闭塞试验假阴性）。37例患者均经及时抗凝、抗血小板、抗血管痉挛或术中机械碎栓等介入治疗，术后6个月改良Rankin量表（mRS）评分仅2例≥2分，其余患者预后良好（mRS评分均＜2分）。结论 颅内动脉瘤介入治疗相关症状性缺血并发症病因复杂，通过及时识别并联合应用抗凝、抗血小板、抗血管痉挛和机械碎栓等介入治疗，多数患者可获得良好预后。

参考文献/References:

［1］ Algra AM， Lindgren A， Vergouwen MDI， et al. Procedural clinical complications， case-fatality risks， and risk factors in endovascular and neurosurgical treatment of unruptured intracranial aneurysms： a systematic review and meta-analysis［J］. JAMA Neurol， 2019， 76： 282-293.
［2］ Nieuwkamp DJ， Setz LE， Algra A， et al. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time， according to age， sex， and region： a meta-analysis［J］. Lancet Neurol， 2009， 8： 635-642.
［3］ Molyneux AJ， Kerr RS， Yu LM， et al. International subarachnoid aneurysm trial（ISAT） of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms： a randomised comparison of effects on survival， dependency， seizures， rebleeding， subgroups， and aneurysm occlusion［J］. Lancet， 2005， 366： 809-817.
［4］ Ihn YK， Shin SH， Baik SK， et al. Complications of endovascular treatment for intracranial aneurysms： management and prevention［J］. Interv Neuroradiol， 2018， 24： 237-245.
［5］ Puentes JC， Quintero ST， Uriza LF， et al. Complicaciones tromboticasy hemorragicas en pacientes con aneurismas cerebrales tratados por via endovasculary surelacion coneluso deantiagregantes plaquetarios： evaluacion descriptiva［J］. Neurocirugia， 2018， 29： 18-24.
［6］ 蒋业清，黄 磊，葛 亮，等． 942例颅内动脉瘤患者血管内治疗围术期出血并发症分析及防治［J］． 中华介入放射学电子杂志， 2019， 7：211-218．
［7］ Park HK， Horowitz M， Jungreis C， et al. Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms［J］. AJNR Am J Neuroradiol， 2005， 26： 506-514.
［8］ 张彦冰，管 生，郭新宾，等． 颅内动脉瘤介入治疗围术期缺血并发症病因分析与防治（附48例报告）［J］． 介入放射学杂志， 2017， 26：291-295．
［9］ Kaiafa G， Savopoulos C， Kanellos I， et al. Anemia and stroke： where do we stand?［J］. Acta Neurol Scand， 2017， 135： 596-602.
［10］ Hetts SW， Turk A， English JD， et al. Stent-assisted coiling versus coiling alone in unruptured intracranial aneurysms in the matrix and platinum science trial： safety， efficacy， and mid-term outcomes［J］. AJNR Am J Neuroradiol， 2014， 35： 698-705.
［11］ Ayling OG， Ibrahim GM， Drake B， et al. Operative complications and differences in outcome after clipping and coiling of ruptured intracranial aneurysms［J］. J Neurosurg， 2015， 123： 621-628.
［12］ Suzuki M， Yoneda H， Ishihara H， et al. Adverse events after unruptured cerebral aneurysm treatment： a single- center experience with clipping/coil embolization combined units［J］. J Stroke Cerebrovasc Dis， 2015， 24： 223-231.
［13］ Andic C， Aydemir F， Kardes O， et al. Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques： is it safe to treat all at once?［J］. J Neurointerv Surg， 2017， 9： 1069-1074.
［14］ Nii K， Inoue R， Morinaga Y， et al. Evaluation of acute in-stent thrombosis during stent-assisted coil embolization of unruptured intracranial aneurysms［J］. Neurol Med Chir（Tokyo）， 2018， 58： 435-441.
［15］ 朱 涛，李 晓，吕丽红，等． 高分辨率C形臂CT联合金属条纹伪影消除技术在颅内动脉瘤支架辅助栓塞中的应用［J］． 介入放射学杂志， 2019， 28：826-831．
［16］ Yang H， Li Y， Jiang Y. Insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysms after stent placement［J］. J Neurosurg， 2016， 125： 247-253.
［17］ Dornbos DR， Katz JS， Youssef P， et al. Glycoprotein Ⅱb/Ⅲa inhibitors in prevention and rescue treatment of thromboembolic complications during endovascular embolization of intracranial aneurysms［J］. Neurosurgery， 2018， 82： 268-277.
［18］ Kim S， Choi JH， Kang M， et al. Safety and efficacy of intra-venous tirofiban as antiplatelet premedication for stent-assisted coiling in acutely ruptured intracranial aneurysms［J］. AJNR Am J Neuroradiol， 2016， 37： 508-514.
［19］ Jeong HW， Jin SC. Intra-arterial infusion of a glycoprotein Ⅱb/Ⅲa antagonist for the treatment of thromboembolism during coil embolization of intracranial aneurysm： a comparison of abciximab and tirofiban［J］. AJNR Am J Neuroradiol， 2013， 34： 1621-1625.
［20］ Zhang K， Wang ZL， Gao BL， et al. Use of a first large-sized coil versus conventional coils for embolization of cerebral aneurysms： effects on packing density， coil length， and durable occlusion［J］. World Neurosurg， 2019， 127： e685-e691.
［21］ 刘 东，吕 明，李佑祥，等． 急性出血期颅内动脉瘤血管内栓塞术中局部肝素化的应用［J］． 中华神经外科杂志， 2014， 30：1081-1084．
［22］ 张法永，陈衔城，宋冬雷，等． 颈内动脉球囊闭塞试验的病例回顾［J］． 中国临床神经科学， 2006， 14：65-68．

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备注/Memo

备注/Memo:
（收稿日期：2020-02-12）
（本文编辑：边 佶）
更新日期/Last Update: 2021-02-22