Clinical analysis on 16 cases of cerebral rebleeding after stent-assisted embolization of ruptured intracranial aneurysm

Song Zhang, S. Guan
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Abstract

Objective To analyze the causes and prevention of cerebral rebleeding after stent-assisted embolization of ruptured intracranial aneurysm Methods A total of 655 patients who underwent single-stent-assisted spring coil embolization of an intracranial ruptured aneurysm from January 2011 to December 2017 in the First Affiliated Hospital of Zhengzhou University were selected. Of them, 16 patients with single aneurysms had perioperative surgery-related re-hemorrhage, 4 males and 12 females, aged 21 to 84 years. The re-hemorrhage and clinical outcomes of 16 patients were counted, and the modified Rankin (mRS) score was evaluated. Results The incidence of perioperative rebleeding in 655 patients was 2.4% (16/655). In the 16 cases, 9 cases had intraoper-ative aneurysm rebleeding, 5 cases died, 1 case had mRS score 4 points, and 3 cases mRS score 1 point. There were 7 cases of postoperative rebleeding, 5 cases of aneurysm rebleeding, 4 cases of death, 1 case of decompressive craniectomy after interventional therapy, and mRS score was 4 points at discharge. Two cases of brain parenchymal hemorrhage, 1 case of death, 1 case of cerebral infarction after discontinuation of dual antiplatelet aggregation drugs, mRS score was 2 points at discharge. Conclusions The causes of rebleeding after interventional treatment of ruptured aneurysm are complicated. For surgical rebleeding, the anti-platelet aggregation drugs application scheme can be adjusted according to the patients’situation, or interventional remedy, surgical combined treatment, effective technical level of operators can be used for effective prevention. Key words: Intracranial aneurysm; Subarachnoid hemorrhage; Stent-assisted embolization
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支架辅助栓塞颅内动脉瘤破裂后再出血16例临床分析
目的分析颅内破裂动脉瘤支架辅助栓塞后脑再出血的原因及预防方法选择2011年1月至2017年12月郑州大学第一附属医院行单支架弹簧圈栓塞术的颅内破裂动脉瘤患者655例。其中单动脉瘤发生围手术期再出血16例,男4例,女12例,年龄21 ~ 84岁。统计16例患者的再出血及临床转归,并评估改良Rankin (mRS)评分。结果655例患者围手术期再出血发生率为2.4%(16/655)。16例患者中9例发生术中动脉瘤再出血,5例死亡,1例mRS评分4分,3例mRS评分1分。术后再出血7例,动脉瘤再出血5例,死亡4例,介入治疗后行减压开颅术1例,出院时mRS评分为4分。停用双抗血小板聚集药物后脑实质出血2例,死亡1例,脑梗死1例,出院时mRS评分为2分。结论动脉瘤破裂介入治疗后再出血原因复杂。对于手术再出血,可根据患者情况调整抗血小板聚集药物的应用方案,或介入治疗、手术联合治疗,可采用操作人员的有效技术水平进行有效预防。关键词:颅内动脉瘤;蛛网膜下腔出血;Stent-assisted栓塞
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