Introduction

Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion.

Methods

This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results.

Results

Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%.

Conclusion

The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.

中文翻译：

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血栓弹力图 (TEG) 结果可预测接受血流改道治疗的未破裂颅内动脉瘤患者的缺血性和出血性并发症

介绍

血流改道是治疗颅内动脉瘤的有效方法，但与缺血性和出血性并发症有关。接受血流改道治疗的患者需要双重抗血小板治疗和随后的血小板功能测试。在我们的机构，血栓弹力图与血小板绘图 (TEG-PM) 是首选测试。本研究的主要目的是确定 TEG 参数，这些参数可预测接受选择性血流改道治疗的患者的术后并发症。

方法

这是一项对 118 名接受血流改道治疗的未破裂颅内动脉瘤患者的回顾性研究。数据是通过图表审查收集的。进行双变量分析以确定患有缺血性中风或腹股沟血肿的患者的重要变量。为具有统计学意义的 TEG 参数构建 ROC 曲线。使用二分法 TEG 结果重复双变量分析。

结果

经历有症状的缺血性中风的患者有中风史（p 值 = 0.007）、较大的动脉瘤颈宽度（p 值 = 0.017）和较高的 alpha 角（p 值 = 0.013）。缺血性并发症的截止点是 ROC 曲线上的 63°，灵敏度为 100%，特异性为 65%。经历过腹股沟血肿的患者与健康同龄人没有区别，但 alpha 角较低 (p 值 = 0.033)。出血并发症的截止点为 53.3°，敏感性为 82%，特异性为 67%。

结论

TEG-PM 的 Alpha 角参数对选择性血流改道后中枢神经系统的缺血并发症和穿刺部位的出血并发症具有相当大的预测能力。