| Part I Risk factors of perioperative complications and clinical outcomes in stent-assisted coiling of acutely rupturedintracranial aneurysmObjective: By analyzing the perioperative technical related complications and clinical outcomes in patients diagnosed as ruptured intracranial aneurysms and treated with stent-assisted coiling embolization,we aimed to identify the potential risk factors that can benefit clinical practice.Methods : Patients with RIA treated with SAC embolization in Changhai Hospital,the Navy Military Medical University from January 2012 to June 2018 were retrospectively reviewed.Perioperative technical related complications and clinical outcomes were analyzed by using univariable analysis and multivariate logistic regression analysis to identify the potential risk factors.Results:(1)A total of 509 patients underwent SAC were involved in the study,male in 170 and female in 339 cases.197(38.7%)ceses received loading dose of dual-antiplatelet therapy,while 312(61.3%)cases received intravenous administration of tirofiban introprocedure instead preoperatively instead.(2)Perioperative ischemic complications occurred in 28 cases(5.5%),multivariate regression analysis identified that aneurysm located at the bifurcation of blood vessel(p=0.001,or=4.108)was an independent risk factor for ischemic complications.(3)Perioperative hemorrhagic complications occurred in 25 cases(4.9%),multivariate regression analysis identified that age(27)60 years(p=0.014,OR=3.574)was an independent risk factor for bleeding complications.(4)81 patients(15.9%)were assessed as mRS score of 3~5 at discharge,and 27 patients(5.3%)died within 30 days.The poor prognosis rate was 21.2%(108/509).Multivariate analysis showed age(29)80 years(p=0.002,OR=7.687),Hunt-Hess 3~5 class(p=0.001,OR=4.905),ischemic complications(p(27)0.001,OR=7.804)and hemorrhagic complications(p(27)0.001,OR=39.317)were independent risk factors associated with poor prognosis.Compared with patients with mild coma(GCS 13~15)at admission,the risk of poor prognosis,increased to 6 times(p=0.001,OR=6.019)in patients with moderate coma(GCS 9~12),and to 12.8 times(p(27)0.001,OR=12.800)in patients with severe coma(GCS 3~8).Conclusion: For patients with RIA treated with SAC,aneurysms located at the vascular bifurcation was an independent risk factor for ischemic complications;age(27)60 years was an independent risk factor for bleeding complications;patients with poor clinical condition had a poor prognosis at discharge,perioperative ischemic and hemorrhagic complications were independent risk factors for poor prognosis.Part II Comparison of different doses of tirofiban in stent-assisted coiling of acutely ruptured intracranial aneurysmsObjective: To compare the safety and efficacy of different doses of tirofiban in stent-assisted coiling of acutely ruptured intracranial aneurysms.Methods: Patients diagnosed as RIA and treated with SAC embolization in Changhai Hospital,the Navy Military Medical University from January 2014 to June 2018 were retrospectively reviewed.Patients were divided into either a standard group(10ug/kg intravenous bolus within 3min,maintained with 0.15ug/kg/min)or a half-dose group(5ug/kg intravenous bolus within 3min,maintained with 0.075ug/kg/min)according to the dose of tirofiban received intraoperatively.Demographic information,aneurysm characteristics,perioperative complications,immediate angiographic results and clinical outcome at discharge were compared between groups.Results:(1)A total of 309 patients underwent SAC embolization successfully were involved in the study,with 170 cases in the standard group and 339 cases in half-dose group.(2)Proportion of wide-neck aneurysms(91.8% versus 79.1%,p=0.006),nonsaccular aneurysms(25.5% versus 9.5%,p(27)0.001),and use of Lvis stent(95.9% versus 73.5%,p(27)0.001)were higher in the half-dose group.No significant differences were found between groups in other baseline characteristics.(3)Ischemic complications occurred in 15 cases(4.9%),including 11 cases(5.2%)in the standard group and 4 cases(4.2%)in the half-dose group(p>0.05).Aneurysm rebleeding was found in 13 cases(4.2%)and all occurred in the standard group,the difference between groups was statistically significant(6.2% versus 0,p=0.011).The rate of early rebleeding(10 cases)was statistically significant between groups(4.7% versus 0,p=0.034);eight(80%)of the early rebleeding complications occurred during the maintenance period of tirofiban within 10 hours after the procedure,3 cases disabled and 5 cases died eventually.(4)The immediate embolism rate,residual neck rate and sac residual rate of the standard group and the half-dose group were 39.8%,18.5%,41.7% and 55.1%,9.2%,35.7%,respectively(p=0.020).No significant differences were found between groups in clinical status(m RS)at discharge.Conclusion: Intravenous administration of tirofiban in stent-assisted coiling of ruptured intracranial aneurysms was feasible and safe,a halving dose of tirofiban may reduce the risk of rebleeding. |
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