PDF(Pubmed)
Abstract：
UNASSIGNED: Ischemic complications develop after elective coil embolization procedures at a certain rate. The prevention of these events has been a longstanding issue for many interventional neuroradiologists. This study aimed to clarify whether procedural ischemic events after unruptured aneurysm embolization decrease over time with perioperative anti-thromboembolic treatment or surgical experience.
UNASSIGNED: This study included patients with cerebral aneurysms in our institution between July 2012 and June 2020. Dual-antiplatelet therapy (DAPT) was performed (Phase 1). Thromboembolic events developed at a certain rate; thus, rivaroxaban was administered with single-antiplatelet therapy (SAPT) to improve thromboembolic results (Phase 2), showing better outcomes than in Phase 1. Subsequently, DAPT was administered again (Phase 3). Ischemic complications were evaluated in each phase or compared between the DAPT group and the direct oral anticoagulant (DOAC) with the clopidogrel (DOAC+SAPT) group.
UNASSIGNED: Relatively, fewer symptomatic ischemic events were noted in Phase 2 or the DOAC+SAPT group, but the outcome was not better in Phase 3 than in Phase 2. Symptomatic complications were more common in Phase 3 than in Phases 1 and 2.
UNASSIGNED: Ischemic complications occurred at a certain rate after endovascular procedures for unruptured aneurysms. The incidence did not decrease over time; particularly, standard DAPT plus postoperative anti-thromboembolic medication did not adequately decrease complications in Phase 3 compared to Phases 1 and 2. Therefore, accumulated experience or a learning curve could not explain the results. DOAC administration might decrease the risk of these events, but further accumulation of evidence or prospective investigation is warranted.
UNASSIGNED: This study included patients with cerebral aneurysms in our institution between July 2012 and June 2020. Dual-antiplatelet therapy (DAPT) was performed (Phase 1). Thromboembolic events developed at a certain rate; thus, rivaroxaban was administered with single-antiplatelet therapy (SAPT) to improve thromboembolic results (Phase 2), showing better outcomes than in Phase 1. Subsequently, DAPT was administered again (Phase 3). Ischemic complications were evaluated in each phase or compared between the DAPT group and the direct oral anticoagulant (DOAC) with the clopidogrel (DOAC+SAPT) group.
UNASSIGNED: Relatively, fewer symptomatic ischemic events were noted in Phase 2 or the DOAC+SAPT group, but the outcome was not better in Phase 3 than in Phase 2. Symptomatic complications were more common in Phase 3 than in Phases 1 and 2.
UNASSIGNED: Ischemic complications occurred at a certain rate after endovascular procedures for unruptured aneurysms. The incidence did not decrease over time; particularly, standard DAPT plus postoperative anti-thromboembolic medication did not adequately decrease complications in Phase 3 compared to Phases 1 and 2. Therefore, accumulated experience or a learning curve could not explain the results. DOAC administration might decrease the risk of these events, but further accumulation of evidence or prospective investigation is warranted.
摘要：
■选择性弹簧圈栓塞手术后发生缺血性并发症。对于许多介入神经放射学家来说，预防这些事件一直是一个长期存在的问题。本研究旨在阐明围手术期抗血栓栓塞治疗或手术经验是否使未破裂动脉瘤栓塞后的手术缺血事件随时间减少。
■这项研究纳入了2012年7月至2020年6月在我们机构患有脑动脉瘤的患者。进行双重抗血小板治疗（DAPT）（第一阶段）。血栓栓塞事件以一定的速度发展；因此，利伐沙班与单一抗血小板治疗（SAPT）一起使用以改善血栓栓塞结果（第2阶段），表现出比第一阶段更好的结果。随后，再次施用DAPT(阶段3)。在每个阶段评估缺血并发症，或比较DAPT组和直接口服抗凝剂（DOAC）和氯吡格雷（DOACSAPT）组之间的缺血并发症。
■相对而言，在2期或DOAC+SAPT组中，症状性缺血事件较少，但第3阶段的结果并不比第2阶段好。症状性并发症在第3阶段比在第1和第2阶段更常见。
■未破裂动脉瘤的血管内手术后，缺血性并发症的发生率一定。发病率并没有随着时间的推移而下降；特别是，与第1阶段和第2阶段相比,第3阶段的标准DAPT加术后抗血栓栓塞药物并不能充分减少并发症.因此,积累的经验或学习曲线无法解释结果。DOAC管理可能会降低这些事件的风险，但需要进一步积累证据或进行前瞻性调查。
■这项研究纳入了2012年7月至2020年6月在我们机构患有脑动脉瘤的患者。进行双重抗血小板治疗（DAPT）（第一阶段）。血栓栓塞事件以一定的速度发展；因此，利伐沙班与单一抗血小板治疗（SAPT）一起使用以改善血栓栓塞结果（第2阶段），表现出比第一阶段更好的结果。随后，再次施用DAPT(阶段3)。在每个阶段评估缺血并发症，或比较DAPT组和直接口服抗凝剂（DOAC）和氯吡格雷（DOACSAPT）组之间的缺血并发症。
■相对而言，在2期或DOAC+SAPT组中，症状性缺血事件较少，但第3阶段的结果并不比第2阶段好。症状性并发症在第3阶段比在第1和第2阶段更常见。
■未破裂动脉瘤的血管内手术后，缺血性并发症的发生率一定。发病率并没有随着时间的推移而下降；特别是，与第1阶段和第2阶段相比,第3阶段的标准DAPT加术后抗血栓栓塞药物并不能充分减少并发症.因此,积累的经验或学习曲线无法解释结果。DOAC管理可能会降低这些事件的风险，但需要进一步积累证据或进行前瞻性调查。
