[1]廖旭兴　钟伟健　董安石　梁铭钦　周思捷　邓其峻　王　辉　马廉亭.替罗非班在颅内破裂动脉瘤急性期支架辅助弹簧圈栓塞中的应用[J].中国临床神经外科杂志,2019,(11):672-674.[doi:10.13798/j.issn.1009-153X.2019.11.011]
　LIAO Xu-xing,ZHONG Wei-jian,DONG An-shi,et al.Application of tirofiban in stent-assisted coil embolization of ruptured intracranial aneurysms in acute phase[J].,2019,(11):672-674.[doi:10.13798/j.issn.1009-153X.2019.11.011]
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替罗非班在颅内破裂动脉瘤急性期支架辅助弹簧圈栓塞中的应用()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2019年11期
页码:
672-674
栏目:
论著
出版日期:
2019-11-25

文章信息/Info

Title:
Application of tirofiban in stent-assisted coil embolization of ruptured intracranial aneurysms in acute phase
文章编号:
1009-153X（2019）11-0672-03
作者:
廖旭兴　钟伟健　董安石　梁铭钦　周思捷　邓其峻　王　辉　马廉亭
430070 武汉，中国人民解放军中部战区总医院神经外科（廖旭兴、马廉亭）528000 广东，佛山市第一人民医院血管及介入神经外科（廖旭兴、钟伟健、董安石、梁铭钦、周思捷、邓其峻、王　辉）
Author(s):
LIAO Xu-xing1; 2;  ZHONG Wei-jian2;  DONG An-shi2;  LIANG Ming-qin2;  ZHOU Si-jie2;  DENG Qi-jun2;  WANG Hui2;  MA Lian-ting1.
1. Department of Neurosurgery, General Hospital, Central Theater, PLA, Wuhan 430070, China; 2. Department of Vascular and Interventional Neurosurgery, The First People's Hospital of Foshan City, Foshan 528000, China
关键词:
颅内破裂动脉瘤; 急性期; 血管内栓塞; 支架; 替罗非班; 可行性
Keywords:
Intracranial ruptured aneurysm;  Tirofiban;  Stent-assited coil embolization;  Acute stage;  Safety;  Feasibility
分类号:
R 743.9; R 815.2
DOI:
10.13798/j.issn.1009-153X.2019.11.011
文献标志码:
A
摘要:
目的 探讨在颅内动脉瘤破裂出血急性期支架辅助弹簧圈栓塞术中应用替罗非班的安全性和可行性。方法 回顾性分析2016年1月至2018年6收治的36例颅内破裂动脉瘤的临床资料。均在急性期应用支架辅助弹簧圈栓塞治疗，支架释放前15 min静脉推注替罗非班，1 h后持续静脉泵入，并维持12~18 h。结果 术中出现动脉瘤破裂2例，支架内急性血栓形成2例。栓塞前后行侧脑室钻孔外引流术4例，替罗非班使用期间未见出血，后期穿刺道出血2例，未见大血肿。术后维持用药期间发生急性脑梗死4例。出院时，GOS评分5分29例，4分1例，3分5例，2分1例。结论 在颅内动脉瘤破裂出血急性期，需要支架辅助弹簧圈栓塞时，静脉应用替罗非班抗血小板聚集是安全、有效的。
Abstract:
Objective To investigate the safety and feasibility of terofiban in stent-assisted coil embolization in acute stage of ruptured intracranial aneurysms. Methods The clinical data of 36 patients with ruptured intracranial aneurysm who were admitted to our hospital from January 2016 to June 2018 were analyzed retrospectively. All the patients were treated with stent-assisted coil embolization in the acute phase. The tirofiban was injected intravenously 15 minutes before the stent release, and continued to be injected intravenously 1 hour later, and then maintained for 12 to 18 hours. Results The aneurysm rupture occurred in 2 patients during the embolization. The acute thrombosis in stent occurred in 2 patients after the embolization. The lateral ventricular drainages were performed in 4 patients who had no bleeding during the use of tirofiban, but the puncture passage bleeding after stopping the use of tirofiban occurred in 2 patients who had no large hematomas. Acute cerebral infarction occurred in 4 patients during the use of tirofiban. According the GOS score at discharge, 29 patients were rated with 5 points, 1 with 4 points, 5 with 3 points and 1 with 2 points. Conclusions In the acute stage of ruptured intracranial aneurysm, it is safe and effective to apply tirofiban intravenously to prevent platelet aggregation when the stent-assisted coil embolization is needed.

参考文献/References:

[1] 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. [2] Lodi YM, Latorre JG, El-Zammar Z, et al. Stent assisted coiling of the ruptured wide necked intracranial aneurysm [J]. J Neurointerv Surg, 2012, 4(4): 281-286. [3] Muto M, Giurazza F, Ambrosanio G, et al. Stent-assisted coiling in ruptured cerebral aneurysms: multi-center experience in acute phase [J]. Radiol Med, 2017, 122: 43- 52. [4] Wang ZL, Liang XD, Li XT, et al. Intravenous administra- tion of tirofiban versus loading dose of oral clopidogrel for preventing thromboembolism in stent-assisted coiling of intracranial aneurysms [J].Int J Stroke, 2017, 12: 553-559. [5] 金二亮，祝　源，杨　李，等. 替罗非班在颅内动脉瘤支架 辅助栓塞术中抗血小板聚集的临床研究[J]. 中华神经外 科杂志，2017，33（4）：349-353. [6] 梁晓东，王子亮，李天晓，等. 替罗非班在颅内破裂动脉瘤 介入治疗中预防性应用研究[J]. 介入放射学杂志，2015， 24 （12）:1034-1038. [7] 牟汝涛，刘一之，倪才方，等. 替罗非班在支架辅助颅内动 脉瘤栓塞中安全性和有效性[J]. 中国介入影像与治疗 学，2017，14（3）：129-133.

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备注/Memo

备注/Memo:
基金项目：佛山市医学科技攻关项目（201308089；20151020138）；佛山市医学科研立项课题（20180051）；佛山市“十三·五”医学重点专科基金资助（2016906）；佛山市杰出青年医学人才基金（2018132）通讯作者：马廉亭，E-mail：mlt1937@163.com（2019-08-29收稿，2019-10-29修回）
更新日期/Last Update: 2019-11-20