替罗非班治疗支架辅助弹簧圈栓塞动脉瘤术中急性血栓形成

Intra-arterial tirofiban thrombolysis for acute thromboembolism during stent-assisted coil embolization for ruptured intracranial aneurysms

摘要:

目的 探讨动脉内灌注盐酸替罗非班在处理支架辅助弹簧圈栓塞颅内动脉瘤时术中急性血栓的有效性及安全性。方法 收集2013年1月至2017年6月11例行颅内动脉瘤栓塞术中发生血栓患者，发生血栓后，均于微导管内靶向灌注盐酸替罗非班6ml，同时静脉泵注5ml/h，然后每5~10分钟造影观察血管溶通情况，直至血栓消失或血管开通。术后进行CT或MRI随访，观察有无脑梗塞或脑出血。结果 11例术中造影血管均完全再通，术后第1天、第7天及术后1月行头颅CT或MRI检查，均未发现与手术相关脑梗塞和脑出血的发生。结论 支架辅助弹簧圈栓塞颅内动脉瘤时，术中出现急性血栓并发症时，经动脉靶向灌注盐酸替罗非班是一种安全、有效的方法。

Abstract:

Objective To investigate the efficacy and safety of intra-arterial infusion of tirofiban hydrochloride in managing acute thromboembolism occurring during stent-assisted coil embolization for ruptured intracranial aneurysms.Methods A total of 11 patients who developed acute thromboembolism during embolization for intracranial aneurysms from January 2013 to June 2017 were enrolled in this study. After thromboembolism occurred, targeted infusion of tirofiban hydrochloride (6 ml) was carried out using a microcatheter; meanwhile, tirofiban hydrochloride was given by intravenous pumping at 5 ml/h. Then, the recanalization of the vessels was assessed by angiography every 5-10 minutes until the thrombus disappeared or the vessels were recanalized. Computed tomography (CT) or magnetic resonance imaging (MRI) follow-up was performed postoperatively to observe the presence or absence of cerebral infarction or hemorrhage.Results Angiography performed during the procedure showed that all the diseased vessels of the 11 patients were recanalized, and no cerebral infarction or hemorrhage associated with the operation was detected on brain CT or MRI at 1 and 7 days and a month after the operation.Conclusions For acute thromboembolism occurring during stent-assisted coil embolization for ruptured intracranial aneurysms, intra-arterial infusion of tirofiban is a safe and effective treatment.