Bleeding complications related to external ventricular drainage placement in patients with ruptured intracranial aneurysms: a single-center study.

IF 1.6 4区 医学 Q2 SURGERY Frontiers in Surgery Pub Date : 2024-10-15 eCollection Date: 2024-01-01 DOI:10.3389/fsurg.2024.1403668
Yue Tang, Xiangping Zhong, Tingting Lin, Fujun Zuo, Min Fu, Li Wang, Xiaodu Yu, Dong Liu, Jincan Zhang
{"title":"Bleeding complications related to external ventricular drainage placement in patients with ruptured intracranial aneurysms: a single-center study.","authors":"Yue Tang, Xiangping Zhong, Tingting Lin, Fujun Zuo, Min Fu, Li Wang, Xiaodu Yu, Dong Liu, Jincan Zhang","doi":"10.3389/fsurg.2024.1403668","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Acute aneurysmal rupture can be treated with endovascular therapy or surgical clipping. For patients with concurrent acute hydrocephalus, the placement of an external ventricular drainage (EVD) is required. This study aims to investigate the impact of pre-treatment EVD placement on rebleeding in ruptured aneurysms and to examine the influence of dual antiplatelet therapy and the sequencing of dual antiplatelet therapy with EVD placement on EVD-related hematomas.</p><p><strong>Methods: </strong>We reviewed the clinical data of 83 patients with ruptured aneurysms who underwent EVD placement from a total of 606 aneurysm patients consecutively admitted between January 2018 and January 2023. The analysis focused on the impact of pre-treatment EVD placement on aneurysmal rebleeding and the effect of dual antiplatelet therapy and its sequencing with EVD placement on EVD-related hematomas.</p><p><strong>Results: </strong>Among the 503 patients with ruptured aneurysms, 83 required EVD placement. EVD was placed before aneurysm treatment in 63 patients and after treatment in 20 patients. The number of aneurysmal rebleeding cases in the pre-treatment EVD group and non-EVD group was 1 (1.6%) and 20 (4.8%), respectively (<i>p</i> = 0.406). 31 patients (37.3%) underwent stent-assisted embolization or flow diversion requiring dual antiplatelet therapy, while 52 patients (62.7%) underwent simple embolization or surgical clipping without antiplatelet therapy. EVD-related hematomas occurred in 14 patients (16.9%), with 10 cases (32.3%) in those receiving dual antiplatelet therapy and 4 cases (7.7%) in those not receiving antiplatelet therapy (<i>p</i> = 0.01). Among 16 patients who had EVD placed before dual antiplatelet therapy, 4 (25%) developed EVD-related hematomas. Of the 15 patients who had EVD placed after dual antiplatelet therapy, 6 (40%) developed EVD-related hematomas (<i>p</i> = 0.458).</p><p><strong>Conclusion: </strong>In patients with aneurysmal subarachnoid hemorrhage (aSAH) and acute hydrocephalus, the placement of EVD before aneurysm treatment does not increase the risk of rebleeding. However, dual antiplatelet therapy increases the risk of EVD-related hematoma, and the sequence of EVD placement relative to dual antiplatelet therapy does not appear to significantly affect the outcome of EVD-related hematoma.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11518839/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fsurg.2024.1403668","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: Acute aneurysmal rupture can be treated with endovascular therapy or surgical clipping. For patients with concurrent acute hydrocephalus, the placement of an external ventricular drainage (EVD) is required. This study aims to investigate the impact of pre-treatment EVD placement on rebleeding in ruptured aneurysms and to examine the influence of dual antiplatelet therapy and the sequencing of dual antiplatelet therapy with EVD placement on EVD-related hematomas.

Methods: We reviewed the clinical data of 83 patients with ruptured aneurysms who underwent EVD placement from a total of 606 aneurysm patients consecutively admitted between January 2018 and January 2023. The analysis focused on the impact of pre-treatment EVD placement on aneurysmal rebleeding and the effect of dual antiplatelet therapy and its sequencing with EVD placement on EVD-related hematomas.

Results: Among the 503 patients with ruptured aneurysms, 83 required EVD placement. EVD was placed before aneurysm treatment in 63 patients and after treatment in 20 patients. The number of aneurysmal rebleeding cases in the pre-treatment EVD group and non-EVD group was 1 (1.6%) and 20 (4.8%), respectively (p = 0.406). 31 patients (37.3%) underwent stent-assisted embolization or flow diversion requiring dual antiplatelet therapy, while 52 patients (62.7%) underwent simple embolization or surgical clipping without antiplatelet therapy. EVD-related hematomas occurred in 14 patients (16.9%), with 10 cases (32.3%) in those receiving dual antiplatelet therapy and 4 cases (7.7%) in those not receiving antiplatelet therapy (p = 0.01). Among 16 patients who had EVD placed before dual antiplatelet therapy, 4 (25%) developed EVD-related hematomas. Of the 15 patients who had EVD placed after dual antiplatelet therapy, 6 (40%) developed EVD-related hematomas (p = 0.458).

Conclusion: In patients with aneurysmal subarachnoid hemorrhage (aSAH) and acute hydrocephalus, the placement of EVD before aneurysm treatment does not increase the risk of rebleeding. However, dual antiplatelet therapy increases the risk of EVD-related hematoma, and the sequence of EVD placement relative to dual antiplatelet therapy does not appear to significantly affect the outcome of EVD-related hematoma.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
颅内动脉瘤破裂患者脑室外引流置管引起的出血并发症:一项单中心研究。
目的:急性动脉瘤破裂可通过血管内治疗或手术剪切治疗。对于并发急性脑积水的患者,需要放置脑室外引流管(EVD)。本研究旨在探讨治疗前放置 EVD 对动脉瘤破裂再出血的影响,并研究双联抗血小板疗法和双联抗血小板疗法与 EVD 放置的先后顺序对 EVD 相关血肿的影响:我们回顾了2018年1月至2023年1月期间连续收治的总共606名动脉瘤患者中83名接受EVD置管的动脉瘤破裂患者的临床数据。分析的重点是治疗前 EVD 置入对动脉瘤再出血的影响,以及双联抗血小板疗法及其与 EVD 置入的排序对 EVD 相关血肿的影响:在503例动脉瘤破裂患者中,83例需要放置EVD。63名患者在动脉瘤治疗前置入EVD,20名患者在治疗后置入。治疗前 EVD 组和非 EVD 组的动脉瘤再出血病例数分别为 1 例(1.6%)和 20 例(4.8%)(P = 0.406)。31名患者(37.3%)接受了需要双重抗血小板治疗的支架辅助栓塞或血流分流术,52名患者(62.7%)接受了无需抗血小板治疗的单纯栓塞或手术剪切术。14例患者(16.9%)发生了与EVD相关的血肿,其中10例(32.3%)接受了双重抗血小板治疗,4例(7.7%)未接受抗血小板治疗(P = 0.01)。在双联抗血小板治疗前植入 EVD 的 16 例患者中,有 4 例(25%)出现了与 EVD 相关的血肿。在双联抗血小板疗法后置入EVD的15名患者中,有6名(40%)出现了EVD相关血肿(p = 0.458):结论:对于动脉瘤性蛛网膜下腔出血(aSAH)和急性脑积水患者,在动脉瘤治疗前置入 EVD 不会增加再出血的风险。但是,双联抗血小板疗法会增加 EVD 相关血肿的风险,相对于双联抗血小板疗法,放置 EVD 的顺序似乎不会对 EVD 相关血肿的结果产生重大影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Frontiers in Surgery
Frontiers in Surgery Medicine-Surgery
CiteScore
1.90
自引率
11.10%
发文量
1872
审稿时长
12 weeks
期刊介绍: Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
期刊最新文献
Coverage of large soft tissue defects of the lower limb and foot with superficial inferior epigastric artery flap. Robotic colorectal surgery in Latin America: a systematic review on surgical outcomes. Integrating 3D technology with the Sampaio classification for enhanced percutaneous nephrolithotomy in complex renal calculi treatment. Integrative prognostic modeling for stage III lung adenosquamous carcinoma post-tumor resection: machine learning insights and web-based implementation. Extrarenal renal cell carcinoma in the adrenal region: a case report.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1