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| Effect of Different Maintenance Time of Dual Antiplatelet Therapy After Intracranial Aneurysm Stent and Coils Embolization on Delayed Cerebral Ischemia |
| MA Ke, LIAO Xiao, LU Huadong, et al |
| Qinzhou First People's Hospital, Guangxi Qinzhou 535000, China |
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Abstract Objective: To study the different effects of different maintenance time of dual antiplatelet therapy on delayed cerebral ischemia after intracranial aneurysm stent combined with coils embolization. Methods: A retrospective analysis was conducted towards 208 hospitalized patients with intracranial aneurysms, who had stent combined with spring coil embolization between January 2017 and January 2019. Patients were divided into 3 groups, namely the short-term group (maintenance time 3 months, and n = 63), medium-term group (maintenance time 6 months, and n = 87) and the long term group (maintenance time more than nine months, n = 58).The cumulative incidence of delayed cerebral ischemia in the three groups was observed. Kaplan-Meier method was used to calculate the cumulative incidence of delayed cerebral ischemia in the three groups, and Log-rank method was used for comparison between the three groups. Cox proportional regression model was used to analyze the independent influencing factors of delayed cerebral ischemia. Results: Among the 208 patients with intracranial aneurysm, 11 cases of delayed cerebral ischemia occurred, including 5 cases in the short-term group and 6 cases in the medium-term group. The cumulative incidence of delayed cerebral ischemia was higher in the short-term and medium-term groups than in the long-term group, and the differences were significant (P<0.05). Univariate Cox analysis showed that the main risk factors of delayed cerebral ischemia were dual antiplatelet duration, Raymond grade, tumor neck width > 4mm, history of diabetes and age (P<0.05).Multivariate Cox analysis showed that the independent risk factors of delayed cerebral ischemia were mainly dual antiplatelet duration and Raymond grade (P<0.05). Conclusion: In patients with intracranial aneurysms, the maintenance time of different dual antiplatelet therapy after stent combined with coil embolization is 9 months or more, which can effectively reduce the incidence of delayed cerebral ischemia. The incidence of delayed cerebral ischemia in patients with intracranial aneurysms increases with the increase of Raymond grade.
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[1] 刘昊楠,李爱民.动脉瘤性蛛网膜下腔出血后迟发性脑缺血发生机制的研究进展[J].安徽医药,2020,24(12):2333~2336.
[2] 何跃,王玲,欧一博,等.非颈段脊髓血管病变引起的颅内蛛网膜下腔出血:出血原因分析及文献复习[M].第十四届中国医师协会神经外科医师年会摘要集,2019.
[3] 邱硕程,谭钰涵,黄志伟,等.双联抗血小板聚集治疗急性缺血性脑血管病合理用药评价[J].中国药业,2020,29(21):87~90.
[4] 陈素云,赵志新,杨仙鸿,等.NLR和AFR与动脉瘤性蛛网膜下腔出血患者迟发性脑缺血的关系研究[J].浙江医学,2020,42(14):1485~1488.
[5] Muto M,Giurazza F,Ambrosanio G,et al.Stent-assisted coiling in ruptured cerebral aneurysms:multi-center experience in acute phase[J].Radiol Med,2017,16(122):43~52.
[6] Zhao B,Tan X,Yang H,et al.Stent-assisted coiling versus coiling alone of poor-grade ruptured intracranial aneurysms:a multieenter study[J].Neurointelv Surg,2017,24(9):165~168.
[7] Zhang Y,Yang M,Zhang H,et al.Stent-assisted coiling may prevent the recurrence of very small ruptured intracranial aneurysms:a multicenter study[J].World Neurosurg,2017,9(100):22~29.
[8] 刘平,黄海林,钟琪,等.颅内动脉瘤显微手术夹闭与血管内栓塞治疗对延迟性脑缺血的影响[J].西部医学,2019,31(9):1390~1394.
[9] 范高阳,孙彦春,苏春海,等.介入栓塞与手术夹闭治疗颅内动脉瘤术后迟发性脑缺血发生特征对比及危险因素分析[J].中国煤炭工业医学杂志,2018,21(5):512~516. |
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2021, Vol. 27 
