Application of nimodipine and tirofiban in cerebrovascular intervention for acute thrombosis
-
摘要:
目的探讨尼莫地平联合替罗非班在脑血管介入术中急性血栓形成的应用的有效性及安全性。 方法收集2016年5月~ 2019年5月于南方医科大学附属小榄人民医院收治的需要介入检查及治疗的患者共152例，术中发现脑血管痉挛及血栓形成19例，其中男8例，女11例；破裂动脉瘤16例，未破裂动脉瘤3例，支架辅助栓塞12例，单纯弹簧圈栓塞7例；年龄28~81岁（平均48.0岁），在造影或治疗过程中发现血管呈腊肠样改变，管腔变小，血流缓慢，充盈缺损，远端血管不显影，考虑有血管痉挛及急性血栓形成，立即予尼莫地平从导引导管推注，缓解血管痉挛，再序贯应用替罗非班，阻止血栓形成及溶解血栓。 结果19例患者经尼莫地平联合替罗非班经导引导管内推注后，即时造影显示血管痉挛好转，远端血管显影良好；术后复查CT有2例出现腔隙性脑梗塞，其余患者CT未见异常；术后随访1月~1年，所有病例无再发脑梗塞。 结论尼莫地平联合替罗非班在脑血管介入术中急性血栓形成的应用，是有效且安全的，值得临床应用推广。 Abstract:ObjectiveTo investigate the efficacy and safety of nimodipine combined with tirofiban in the treatment of acute thrombosis in cerebrovascular intervention. MethodsFrom May 2016 to May 2019, 152 patients received interventional examination and treatment in Xiaolan People's Hospital affiliated to Southern Medical University. Ninteen cases of cerebral vasospasm and thrombosis were found during operation, including 8 males and 11 females, 16 ruptured aneurysms and 3 unruptured aneurysms, 12 stent-assisted embolizations and 7 spring coil embolizations. The age of these patients ranged from 28 to 81 years, with an average of 48.0 years. During the angiography or treatment process, the blood vessels were found to have sausage-like changes, such as small lumen, slow blood flow, filling defect, distal blood vessels not developed, considering vasospasm and acute thrombosis.The nimodipine was immediate injected through the guiding catheter to relieve vasospasm. The sequential tirofiban was used to prevent thrombosis and dissolve thrombus. ResultsNineteen patients underwent a bolus injection of nimodipine in combination with tirofiban. Immediate angiography showed that the vasospasm was reversed and the distal vascular development was fine. Only two cases of lacunar cerebral infarction were confirmed by postoperative CT scans. CT scans of other 17 cases showed no abnormalities. All patients were followed up for 1 month to 1 year without cerebral infarction. ConclusionThe application of nimodipine combined with tirofiban in acute thrombosis in cerebrovascular intervention is effective and safe. -
Key words:
- nimodipine /
- tirofiban /
- cerebral vasospasm /
- intra-arterial infusion
-
图 1 术前脑血管造影右侧ICA正常，大脑前动脉显影正常
Figure 1. Preoperative cerebral angiography showed normal ICAon the right and normal anterior cerebral arteries
图 2 Guiding到位后不久见右ICA痉挛严重，远端大脑前动脉无显影
Figure 2. Shortly after Guiding was in place, the right ICA spasticity was severe, and the distal anterior cerebral artery was not developed
图 3 动脉推注尼莫地平及替罗非班后，可见血管痉挛解除，远端大脑前动脉显影
Figure 3. After arterial injection of nimodipine and tirofiban, vasospasm was relieved and the distal anterior cerebral artery was developed
图 4 术前脑血管造影左侧ICA正常，大脑前动脉显影正常
Figure 4. Preoperative cerebral angiography with normal ICAon the left and normal anterior cerebral arteries
图 5 Guiding到位后动脉瘤栓塞过程中，见左ICA痉挛严重，局部有血栓形成，远端大脑前动脉无显影
Figure 5. During the embolization of the aneurysm after Guiding is in place, the left ICA spasticity is severe, there is local thrombosis, and the distal anterior cerebral artery is not developed
-
[1] 魏社鹏, 赵继宗.未破裂颅内动脉瘤的研究进展[J].国际神经病学神经外科学杂志, 2017, 44(3): 311-5. http://d.old.wanfangdata.com.cn/Periodical/zgnxgbzz201805007 [2] 贺晓武, 左乔, 黄清海, 等.不同剂量替罗非班在支架辅助栓塞颅内破裂动脉瘤中的应用比较[J].中国脑血管病杂志, 2018, 15(10): 507-9. http://d.old.wanfangdata.com.cn/Periodical/zgnxgbzz201810001 [3] 刘明, 李永奇, 李凯, 等.替罗非班用于治疗颅内动脉瘤栓塞期间的血栓栓塞的临床疗效观察[J].中南医学科学杂志, 2019, 47(5): 527-30. http://d.old.wanfangdata.com.cn/Periodical/nhdxxb-yxb201905022 [4] 梁晓东, 王子亮, 李天晓, 等.替罗非班在颅内破裂动脉瘤介入治疗术中预防性应用研究[J].介入放射学杂志, 2015, 24(12): 1034-8. http://d.old.wanfangdata.com.cn/Periodical/jrfsxzz201512002 [5] 董晓峰, 朱迪, 梁旭光, 等.尼莫地平治疗动脉瘤性蛛网膜下腔出血的效果及对血管内皮因子、炎性因子和HMGB1表达的影响[J].临床神经外科杂志, 2019, 16(3): 262-6. http://d.old.wanfangdata.com.cn/Periodical/lcsjwkzz201903019 [6] 斯良楠, 孙晓川, 张晓冬.经动脉灌注尼莫地平治疗蛛网膜下腔出血后脑血管痉挛[J].中国介入影像与治疗学, 2015, 12(9): 527-31. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgjryxyzlx201509003 [7] 王伊红.超出溶栓时间窗急性缺血性脑卒中患者应用动脉导管局部给予替罗非班治疗的可行性[J].海峡药学, 2019, 31(8): 197-8. http://d.old.wanfangdata.com.cn/Periodical/haixyx201908077 [8] 王乐园, 贺爱荣, 邵泽涛, 等.经动脉导管局部给予替罗非班对超出溶栓时间窗急性缺血脑卒中的疗效分析[J].中国循证心血管医学杂志, 2018, 10(3): 313-5 http://d.old.wanfangdata.com.cn/Periodical/zgxzxxgyxzz201803015 [9] Ryu CW, Park S, Shin HS, et al. Complications in stent-assisted endovascular therapy of ruptured intracranial aneurysms and relevance to antiplatelet administration: a systematic review[J]. Am J Neuroradiol, 2015, 36(9): 1682-8. https://pubmed.ncbi.nlm.nih.gov/26138136/ [10] Derdeyn CP, Cross DT 3rd, Moran CJ, et al. Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils[J]. J Neurosurg, 2002, 96(5): 837-43. doi: 10.3171-jns.2002.96.5.0837/ [11] Brinjikji W, McDonald JS, Kallmes DF, et al. Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms[J]. Stroke, 2013, 44(5): 1343-7. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=WK_LWW2017052520672210 [12] 祝源, 李俊, 杨铭, 等.支架辅助弹簧圈栓塞颅内动脉瘤抗血小板聚集的治疗方案[J].中华神经外科杂志, 2017, 33(7): 728-32. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhsjwkzz98201707019 [13] 梁晓东, 王子亮, 李天晓, 等.盐酸替罗非班在颅内动脉瘤介入治疗中的应用进展[J].中华介入放射学电子杂志, 2016, 4(1): 44-7. http://d.old.wanfangdata.com.cn/Periodical/zhjrfsxdzzz201601013 [14] 黄石, 周峰, 张颖冬.替罗非班在急性缺血性卒中中的研究进展[J].中国脑血管病杂志, 2018, 15(11): 601-6. http://d.old.wanfangdata.com.cn/Periodical/zgnxgbzz201811008 [15] 苏方华, 许志勇, 黎志忠.替罗非班等联合治疗急性冠脉综合征的出血并发症危险因素分析[J].中西医结合心脑血管病杂志, 2016, 14 (5): 542-4. http://d.old.wanfangdata.com.cn/Periodical/zxyjhxnxgbzz201605031 [16] 刘锋, 万周.替罗非班在支架辅助颅内动脉瘤栓塞术的应用[J].现代诊断与治疗, 2016, 27(5): 886-7. http://d.old.wanfangdata.com.cn/Periodical/xdzdyzl201605062 [17] Liang XD, Wang ZL, Li TX, et al. Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms[J]. J Neurointerv Surg, 2016, 8(11): 1148-53. https://jnis.bmj.com/content/8/11/1148 [18] Kim S, Choi JH, Kang M, et al. Safety and efficacy of intravenous tirofiban as antiplatelet premedication for stent-assisted coiling in acutely ruptured intracranial aneurysms[J]. AJNR Am J Neuroradiol, 2016, 37(3):508-14. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=9a48e2371c4959c2408f96223690011e [19] 李捷, 龙霄翱, 李丽球, 等.超选择注射替罗非班治疗颅内动脉瘤栓塞术中急性血栓形成的临床疗效[J].卒中与神经疾病, 2019, 26(1): 55-9. http://d.old.wanfangdata.com.cn/Periodical/zzysjjb201901013 [20] Mohamed S, Riva R, Contin M. Simple and validated UHPLC-MS/ MS analysis of nimodipine in plasma and cerebrospinal fluid of patients with subarachnoid haemorrhage[J]. J Chromatogr B Analyt Technol Biomed Life Sci, 2016, 1028: 94-9. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=19e2a4c399d1d95200afb626d5bfd404 [21] Serrone JC, Maekawa H, Tjahjadi M, et al. Aneurysmal subarachnoid hemorrhage: pathobiology, current treatment and future directions [J]. Expert Rev Neurother, 2015, 15(4):367-80. http://d.old.wanfangdata.com.cn/NSTLQK/NSTL_QKJJ0234390262/ [22] Seker F, Hesser J, Brockmann MA, et al. Pharmacokinetic modeling of intra-arterial nimodipine therapy for subarachnoid hemorrhagerelated cerebral vasospasm[J]. Clin Neuroradiol, 2017, 27(2): 199- 203. [23] 焦继超, 马玉德, 李小亮, 等.尼莫地平对蛛网膜下腔出血大鼠海马CA1区自噬的影响[J].中国脑血管病杂志, 2019, 16(2): 76-81. http://d.old.wanfangdata.com.cn/Periodical/zgnxgbzz201902004 [24] Bork K, Wurm F, Haller H, et al. Neuroprotective and neuroregenerative effects of nimodipine in a model system of neuronal differentiation and neurite outgrowth[J]. Molecules, 2015, 20(1): 1003-13. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=molecules-20-01003 [25] Bele S, Proescholdt MA, Hochreiter A, et al. Continuous intraarterial nimodipine infusion in patients with severe refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a feasibility study and outcome results[J]. Acta Neurochir (Wien), 2015, 157(12): 2041-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287266/ [26] Heffren J, McIntosh AM, Reiter PD. Nimodipine for the prevention of cerebral vasospasm after subarachnoid hemorrhage in 12 children [J]. Pediatr Neurol, 2015, 52(3):356-60. https://www.ncbi.nlm.nih.gov/pubmed/25585913 [27] 杨彬源, 陈桂增, 王本艳, 等.马来酸桂哌齐特联合尼莫地平治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛疗效观察[J].海南医学, 2017, 28 (6): 971-3. http://d.old.wanfangdata.com.cn/Periodical/hainanyx201706037 [28] 纪志伟, 刘振坤.维拉帕米和尼莫地平灌注对动脉瘤性蛛网膜下腔出血后脑血管痉挛的脑血流动力学影响[J].山西医药杂志, 2016, 45 (5): 577-8. http://d.old.wanfangdata.com.cn/Periodical/sxyyzz201605033 [29] 李峰, 千超, 肖学谦.动脉内尼莫地平反复灌注联合口服辛伐他汀治疗蛛网膜下腔出血后症状性脑血管痉挛的临床疗效[J].神经损伤与功能重建, 2017, 12(1): 73-5. http://d.old.wanfangdata.com.cn/Periodical/gwyx-wlyxykf201701022 [30] 李捷, 龙霄翱, 黄拔齐, 等.经颈内动脉输注尼莫地平治疗动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛的临床分析[J].中国当代医药, 2016, 23(13): 53-6. http://d.old.wanfangdata.com.cn/Periodical/jkr201613017 -
下载:
点击查看大图
图(6)
计量
- 文章访问数: 598
- HTML全文浏览量: 322
- PDF下载量: 5
- 被引次数: 0
