围手术期预防性使用替罗非班序贯双联抗血小板治疗在支架辅助弹簧圈栓塞颅内动脉瘤中的安全性和有效性分析OA

Objective To investigate the safety and efficacy of perioperative prophylactic tirofiban sequential dual antiplatelet therapy in stent-assisted coil embolization for intracranial aneurysms. Methods A retrospective cohort study consecutively enrolled patients with ruptured or vulnerable intracranial aneurysms who underwent stent-assisted coil embolization at People's Hospital of Hunan Provincial between January 2020 and December 2023.Based on the perioperative antiplatelet strategy,patients were divided into the tirofiban sequential dual antiplatelet therapy(the aspirin plus clopidogrel)group and the aspirin plus dual antiplatelet therapy group.Baseline characteristics,including age,sex,smoking history,alcohol use,comorbidities,aneurysm location,maximum aneurysm diameter,and preoperative Hunt-Hess grade,were collected and compared between the two groups.The efficacy endpoints of perioperative antiplatelet therapy were thromboembolic events(intraoperative and within 3 days postoperatively)and delayed cerebral ischemia(3-14 days postoperatively).The safety endpoint was intracranial hemorrhage(intraoperative and within 3 days postoperatively). Results ①A total of 300 patients with intracranial aneurysms who underwent stent-assisted coil embolization and completed 15-day follow-up were ultimately enrolled in the study,including 86 males and 214 females.Of them,175 patients(58％)received dual antiplatelet therapy after the decision for stent-assisted coil embolization,while 125 patients(42％)received intraoperative tirofiban infusion for antiplatelet aggregation followed by sequential dual antiplatelet therapy.②One thromboembolic event(0.80％)occurred in the tirofiban sequential dual antiplatelet therapy group during the perioperative period,while 11 such events(6.29％)occurred in the dual antiplatelet therapy group.Multivariate logistic regression analysis indicated that the tirofiban sequential dual antiplatelet therapy group had a lower risk of thromboembolic events(OR 0.177,95％CI 0.019-0.843,P=0.028).③Two delayed cerebral ischemia events(1.60％)occurred in the tirofiban sequential dual antiplatelet therapy group during the perioperative period,while 13 such events(7.43％)occurred in the dual antiplatelet therapy group.Multivariate logistic regression analysis revealed that the tirofiban sequential dual antiplatelet therapy group showed a lower risk of delayed cerebral ischemia(OR 0.256,95％CI 0.046-0.959,P=0.043).④No intracranial hemorrhage events occurred in the tirofiban sequential dual antiplatelet therapy group during the perioperative period,while two such events(1.14％)occurred in the dual antiplatelet therapy group.Univariate logistic regression analysis demonstrated no statistically significant association between any included factor and perioperative intracranial hemorrhage events. Conclusions Perioperative prophylactic tirofiban sequential dual antiplatelet therapy may be safe and effective in stent-assisted coil embolization for intracranial aneurysms,and this strategy is worthy of further study.