The Predictive Value Of TEG On Ischemic Complications In Unruptured Intracranial Aneurysm Patients Undergoing Stent Placement

Objective:To investigate the predictive value of the thrombelastography(TEG)on perioperative thrombomembolic complications with unruptured intracranial aneurysm(UIAs)after stent-assisted ciol embolization.Methods:The clinical data of thirty-four patients with UIAs treadted by stent-assisted ciol embolization were enrolled in this study from June 2014 to November 2015 in the First Affiliated Hospital of Chongqing Medical University.The blood samples were collected on pre-operation and within postoperative 12 hours.TEG was used to detect the arachidonic acid(AA)inhibition rate,the adenosine monophosphate(ADP)inhibition rate,the maximal concentration of adenosine diphosphate(MAADP),and magnetic resonance diffusion-weighted imaging was peformed within 3-7 days after stent insertion to indentify acute ischemic lesions.Results:15(44.2%)patients with acute ischemic lesions were detected by DWI.In 3(8.8%)patients with ischemic lesions clinical ischemic event was foud during perioperative period.The preoperative ADP inhibition rate [(39.7±14.6)%]in patients with ischemic lesions,which was significantly lower than that of patients without ischemic lesions[(56.8±21.7)%],and the difference was statistically significant(P <0.05).Preoperative MAADP(38.1 ± 14.3)mm was higher than that in patients without ischemic disease(35.7 ± 15.5)mm,but the difference was not statistically significant.There was no significant difference in preoperative AA inhibition rate 、postoperative AA inhibition rate 、 postoperative ADP inhibition rate 、postoperative MAADP in patients with and without icchemic lesions.The incidence of ischemic events was 5/7 with preoperative ADP inhibition rate <30%,including intraoperative acute thrombosis in 2 cases of clinical ischemic complications,the incidence of ischemic events with ADP inhibition rate 31~ 40% and 40 ~50% were 2/4,5/7.Conclusion: The Logistic regression analysis demonstrated that preoperative ADP inhibition rate was associated with postoperative ischemic complication of UIAs after stent-assisted coil embolization.The lower the level of preoperative ADP inhibition,the increased risk of intracranial ischemic events,High risk of event risk with ADP inhibition rate<30%.The ADP inhibition rate measured by TEG is significantly associated with perioperative ischemic events in patients with UIAs after stent-assisted coil embolization.TEG can be helpful for the prevention and treatment of thromboembolic events in patients with unruptured intracranial aneurysms after stent-assisted coil embolization.