PDF(Pubmed)
Abstract：
Dual antiplatelet therapy (DAPT) is a management cornerstone for intracranial aneurysms treated with flow diversion. However, combined dual antiplatelet plus anticoagulation (triple therapy) can be indicated in some patients with important associated risks. Here we present the case of a 72-year-old woman with prior history of subarachnoid hemorrhage who was started on triple therapy (enoxaparin and DAPT) following successful flow diversion of an enlarging but unruptured left fetal posterior communicating artery aneurysm. Her post-procedural course was complicated by in-stent thrombosis in the setting of a missed ticagrelor dose and subsequent development of deep venous thrombosis and pulmonary embolism. An early follow-up angiogram confirmed occlusion of the aneurysm. However, after initiation of triple therapy, the aneurysm partially recanalized and her symptoms recurred. Subsequent discontinuation of enoxaparin lead to prompt aneurysm re-occlusion. To our knowledge, this is the first reported instance of confirmed intra-aneurysmal thrombolysis in a successfully treated aneurysm after triple therapy initiation.
摘要：
双重抗血小板治疗（DAPT）是分流治疗颅内动脉瘤的管理基础。然而,在一些具有重要相关风险的患者中,联合使用双联抗血小板联合抗凝治疗(三联疗法)是可行的.在这里，我们介绍了一名具有蛛网膜下腔出血病史的72岁女性，该女性在成功分流扩大但未破裂的左胎儿后交通动脉瘤后开始接受三联疗法（依诺肝素和DAPT）。在错过替格瑞洛剂量的情况下，她的术后过程因支架内血栓形成以及随后的深静脉血栓形成和肺栓塞的发展而复杂化。早期随访血管造影证实动脉瘤闭塞。然而,在三联疗法开始后，动脉瘤部分复发，症状复发。随后停用依诺肝素会导致动脉瘤再次闭塞。据我们所知,这是在启动三联疗法后成功治疗的动脉瘤中首次报道证实动脉瘤内溶栓的病例.
