摘要
目的探讨颅内动脉瘤支架结合弹簧圈栓塞术后不同双联抗血小板治疗维持时间对迟发性脑缺血的影响。方法连续纳入2010年1月至2017年6月在茂名市人民医院接受支架结合弹簧圈栓塞术治疗的颅内动脉瘤患者416例,进行前瞻性分析。根据术后双联抗血小板治疗维持时间,将患者分为短期组(n=127,持续3个月)、中期组(n=174,持续6个月)、长期组(n=115,持续≥9个月)。采用KaplanMeier方法统计3组迟发性脑缺血累积发生率,Log-rank法进行组间对比。采用Cox比例回归模型分析迟发性脑缺血的独立影响因素。结果术后随访期间416例患者中15例(3.61%,15/416)出现迟发性脑缺血,其中短期组8例、中期组7例,均发生于停用双联抗血小板治疗2个月后。短期组、中期组迟发性脑缺血累积发生率均明显高于长期组(P<0.05)。单因素Cox分析显示年龄、糖尿病史、瘤颈宽>4 mm、Raymond栓塞效果分级、双联抗血小板治疗持续时间是迟发性脑缺血的危险因素(P<0.05),多因素Cox分析显示Raymond栓塞效果分级、双联抗血小板治疗持续时间为迟发性脑缺血独立危险因素(P<0.05)。结论颅内动脉瘤支架结合弹簧圈栓塞术后双联抗血小板治疗时间延长至≥9个月,有助于降低迟发性脑缺血风险。Raymond栓塞效果分级越高,患者越有可能发生迟发性脑缺血。
Objective To investigate the effect of postoperative dual antiplatelet therapy lasting for different time on delayed cerebral ischemia after stenting combined with coil embolization for intracranial aneurysms.Methods The clinical data of 416 patients with intracranial aneurysms,who were admitted to the Maoming Municipal People’s Hospital of China during the period from January 2010 to June 2017 to receive stenting combined with coil embolization therapy,were enrolled in this prospective study.According to the duration of postoperative dual antiplatelet therapy,the patients were divided into short-term group(n=127,lasting for 3 months),medium-term group(n=174,lasting for 6 months),and long-term group(n=115,lasting≥9 months).Kaplan-Meier method was used to calculate the cumulative incidence of delayed cerebral ischemia in the three groups,and log-rankχ~2 test was used to make comparison between each other among the three groups.Cox proportional regression model was adopted to analyze the independent factors nfluencing delayed cerebral ischemia.Results During the follow-up period,15 patients developed delayed cerebral ischemia(3.61%,15/416),including 8 patients in the short-term group and 7 patients in the medium-term group,and delayed cerebral ischemia occurred in 2 months after stopping dual antiplatelet therapy in all the 15 patients.The cumulative incidence of delayed cerebral ischemia in both short-term group and medium-term group was significantly higher than that in long-term group(P<0.05).Univariate Cox analysis demonstrated that age,history of diabetes,aneurysmal neck width>4 mm,Raymond grade of embolization,and duration of dual antiplatelet therapy were the risk factors for delayed cerebral ischemia(P<0.05).Multivariate Cox analysis indicated that Raymond grade of embolization and duration of dual antiplatelet therapy were the independent risk factors for delayed cerebral ischemia(P<0.05).Conclusion Postoperative dual antiplatelet therapy≥9 months can help reduce the risk of delayed cerebral ischemia after stenting combined with coil embolization for intracranial aneurysms.The higher the Raymond embolization effect grade is,the greater the risk of delayed cerebral ischemia would be.
作者
李成林
梁上男
吴炎宇
邓汉顺
LI Chenglin;LIANG Shangnan;WU Yanyu;DENG Hanshun(Section II,Department of Neurosurgery,Maoming People’s Hospital,Maoming,Guangdong Province 525000,China)
出处
《介入放射学杂志》
CSCD
北大核心
2020年第8期815-820,共6页
Journal of Interventional Radiology
关键词
颅内动脉瘤
支架辅助弹簧圈栓塞术
血管内介入治疗
抗血小板治疗
迟发性脑缺血
intracranial aneurysm
stent-assisted coil embolization
endovascular intervention
antiplatelet therapy
delayed cerebral ischemia
