动脉瘤支架置入术后停用抗血小板药可产生血栓风险

CARLSBAD, California (EGMN) –Delayed thrombotic events have been observed following the cessation of double antiplatelet therapy in patients who have received an Enterprise stent for an intracranial aneurysm.

Seven of 213 patients in the Interstate Collaboration of the Enterprise Stent Coiling (ICES) Multicenter Registry experienced a thrombotic event 2-24 weeks after placement of the stent and stopping aspirin and clopidogrel, Dr. J. Mocco reported at the annual meeting of the Society of NeuroInterventional Surgery. Another two patients experienced acute cases of stent thrombosis.

Ten sites in the United States and Puerto Rico participate in the registry to rapidly provide large-volume, real-world results regarding experience in using the Enterprise Vascular Reconstruction Device and Delivery System (J. Neurosurg. 2009;110:35-9) for the treatment of intracranial aneurysms. The stent system is designed to assist in the embolic coiling of wide-neck aneurysms.

In the seven cases, the patients either did not comply with the drug regimen or stopped taking the antiplatelets on the order of the physician.

The data suggest that early cessation of double antiplatelet therapy is not ideal, although it is currently unclear what the optimum time course should be, said Dr. Mocco, an endovascular neurosurgeon affiliated with the University of Florida, Gainseville.

Use of the Enterprise stent to assist with aneurysm coiling was associated with 90% or greater occlusion in 88% of aneurysms. Permanent morbidity (all minor) occurred in 1.4% of patients.

None of the thrombotic events were associated with coil prolapse or parent vessel tortuosity, said Dr. Mocco. Three events had no angiographic corollary and two were diagnosed based on symptoms.

Dr. Mocco gave his presentation during a session sponsored by Codman Neurovascular, the manufacturer of the Enterprise stent. He disclosed that he received no direct financial support from Codman and the data were generated independent of commercial influence, although the University of Florida receives an educational grant and consulting fees from Codman. He is a consultant to several other companies that manufacture cerebrovascular therapies.

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加利福尼亚州卡尔斯巴德(EGMN)——已有研究发现，接受Enterprise 支架置入术的颅内动脉瘤患者在停止双联抗血小板药物治疗后，可出现迟发性血栓事件。

佛罗里达大学盖恩斯维尔分校的血管内神经外科医生J. Mocco博士在神经介入外科学会年会上指出，Enterprise支架弹簧圈治疗州际协作(Interstate Collaboration of the Enterprise Stent Coiling，ICES)多中心登记库的213例患者中有7例在置入该支架并停用阿司匹林和氯吡格雷后2~24周出现血栓事件，另外2例出现急性支架内血栓形成。7例中有的是不依从药物治疗方案，有的则是遵医嘱后才停用抗血小板药。

该登记计划由美国和波多黎各的10个研究单位共同参与，旨在迅速提供有关真实临床环境中应用Enterprise血管重建装置和传送系统(J. Neurosurg. 2009;110:35-9)治疗颅内动脉瘤的大量实验结果。该支架系统是为了辅助弹簧圈栓塞治疗宽颈动脉瘤设计。

Mocco博士表示，尽管目前尚不清楚什么时候才是停止双联抗血小板药物治疗的最佳时机，但从上述数据来看，提前停止这种治疗的效果并不理想。

Enterprise支架辅助弹簧圈治疗可使88%动脉瘤的闭塞程度达到90%或以上，相关永久性并发症(均为轻度)发生率为1.4%。无1起血栓事件与弹簧圈脱出或母血管迂曲相关。3起事件无相关造影表现，2起事件为根据症状诊断。

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