【摘要】 目的 分析未破裂颅内动脉瘤血管内治疗围术期症状性脑缺血并发症的原因与治疗措施。方法 回顾性分析352例未破裂颅内动脉瘤患者的临床资料,确诊24例症状性脑缺血患者,分析原因、治疗措施,采用改良Rankin量表(mRS)评估术后6个月临床预后。结果 脑缺血并发症发生原因为术中急性血栓形成(12例)、穿支动脉闭塞(4例)、闭塞动脉瘤毗邻分支(2例)、术中低血压(2例)、支架内血栓形成脱落(1例),3例原因不明确。急性血栓形成患者术中接受尿激酶或替罗非班补救治疗,完全或部分再通11例,其中2例遗留永久性神经功能缺损、术后6个月mRS评分4分。1例未开通,于术后3d死于大面积脑梗死。另12例患者术后给予抗凝及抗血小板治疗,术后6个月预后良好。术后6个月临床随访,21例(87.5%,21/24)预后良好,2例(8.3%,2/24)预后不良。结论 血管内治疗未破裂动脉瘤围术期症状性脑缺血的原因复杂,可通过术中药物干预、术后联合抗凝及抗血小板等措施进行补救处理。更多还原

【Abstract】 Objective To analyze the cause and therapy of symptomatic cerebral ischemia complications during perioperative period of endovascular treatment for unruptured intracranial aneurysms.Methods 352 patients with unruptured intracranial aneurysms were analyzed retrospectively.A total of 24 cases with symptomatic cerebral ischemia were confirmed, the cause and treatment were analyzed.Clinical prognosis was evaluated by the modified Rankin score(mRS) at 6 months after the operation.Results The causes of cerebral ischemia complications were as follows: intra-procedural acute thrombus formation(n=12),embolization of perforating branches(n=4),embolization of adjacent branches(n=2),intra-procedural hypotension(n=2),stent thrombosis abscission(n=1) and 3 cases had unknown causes.All of the cases encountering intra-procedural acute thrombus formation received intra-arterial rescue therapy with tirofiban or urokinase.Although 11 patients of them achieved complete or partial recanalization, 2 cases developed permanent neurologic deficit with mRS 4 at 6 months after the therapy.One of them did not achieve recanalization and died of large cerebral infarction at 3 days after operation.The remaining 12 cases receiving anticoagulant and antiplatelet therapy achieved good prognosis at 6 months after the therapy.Clinical follow-up was carried at 6 months after the treatment, 21(87.5%,21/24) patients obtained good prognosis and 2(8.3%,2/24) patients achieved poor prognosis.Conclusion The cause of symptomatic cerebral ischemia complication during perioperative period of endovascular treatment for unruptured intracranial aneurysms is complex.Rescue therapy can be carried through intra-procedural administration of pharmacologic agents and combined application of anticoagulation and antiplatelet after operation.更多还原