Antiplatelet Therapy With Tirofiban In Emergency Stent-assisted Embolization Of Intracranial Aneurysms

Background:An intracranial aneurysm is a weakness in the wall of an artery that causes bulging or outpouching of an intracranial blood vessel wall.It is the leading cause of subarachnoid hemorrhage(SAH)and the yearly rate of it was 6-35.6/10million.Both estimated initial mortality and disable rate is high after aneurismal ruptured,so aneurismal ruptured should be early diagnosed and treated.Intracranial stent assisted embolization is one of the main methods for the treatment of intracranial aneurysms.It has the advantages of minimally invasive,safe,effective,low incidence of sequelae,and has been widely accepted and widely used in clinical practice.However,the main complication of stent implantation is stent thrombosis,which seriously affects the therapeutic effect.Therefore,antiplatelet therapy should be performed in patients with intracranial artery stenting.At present,majority doctors applie clopidogrel and aspirin to prevent the formation of thrombosis before,during and after surgery.But for patients with bleeding aneurysms,preoperative antiplatelet drugs are the risk of increased blood,And in case of treatment failure.Patients who need to undergo surgery,so the function of platelets can not be restored in time,can not immediately undergo surgery.So clinicians have a lot to worry about when they make a treatment plan.Therefore,the key to the success of the operation is to apply effective anti platelet aggregation after the operation.In addition to the inhibition of platelet aggregation has obvious effect,but also can dissolve the newly formed thrombus.Tirofiban(timfiban)is a reversible non peptide platelet glycoprotein ?b/?a receptor antagonist.The effect was rapid,the half-life was short,and the platelet function recovered rapidly after stopping the drug.It provides a new choice for antiplatelet therapy of intracranial artery stent implantationObjective:The objective of this study is to investigate the efficacy and safety of antiplatelet with tirofiban in stent-assisted embolization of intracranial aneurysms.Methods:Clinic data of 309 patients in intracranial aneurysm treated with stent-assisted embolization were analyzed retrospectively,including 213 ruptured aneurysms and 79 unruptured aneurysms.After successful stenting,tirofiban was used(intravenous bolus injection 2-4 ?g/kg(2-4 ml),then continued by pumping of 24h for antiplatelet aggregation.Then gradually changed to conventional oral administration of aspirin and clopidogrel.Results:Of 309 patients with intracranial aneurysm were treated,there were complications during the application of tirofiban as following:rerupture in 6 cases(1.9%),thrombosis in 2 cases(0.6%),weasand bleeding 1 case(0.3%).298 Of 309 cases(96%)had transitioned from tirofiban to oral anti platelet aggregation agents successfully 12-24 hours after procedure.There was significant difference in platelet activation rates between before procedure and 1 day after procedure(75.7%±10.4%vs 71.9%±15.9%,P =0.035),and there was also significant difference in platelet activation rates between before procedure and 3 day after procedure(73.2%±13.2%vs27.9%22.1%,P<0.001).Conclusion:Antiplatelet with tirofiban for patients with stent assisted embolization of intracranial aneurysms is relatively safe and effective,according to our program in patients with acute aneurysm ruptured,but it need to pay more attention when it is hemorrhagic tendency.Platelet activation test can objectively reflect the inhibition of platelet,especially assess excessive inhibition,and be helpful to instruct anti-platelet aggregation drugs.