Background

There have been few reports on the use of tirofiban in ruptured intracranial aneurysms and the results were conflicting. However, the safety and efficacy of optimal dosage and the reasonable treatment course of tirofiban have not been determined.

Objective

To determine the safety and efficacy of a new protocol for its prophylactic tirofiban application during the endovascular treatment of ruptured intracranial aneurysms with no oral antiplatelet medications.

Methods

This retrospective study was based on 105 patients with ruptured aneurysms who underwent stent-assisted coiling at our institution between August 2017 and July 2020. Intravenous tirofiban was administered to patients after stent deployment. Tirofiban was administered as an intravenous bolus (5 µg/kg) over a 3 min period immediately after stent deployment, followed by a 0.06–0.08 µg/kg/min maintenance infusion for 12–24 h. Dual oral antiplatelet therapy was overlapped with half the tirofiban dose 2 h before the cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded.

Results

This study included a total of 105 patients with ruptured intracranial aneurysms, who underwent stent-assisted coiling. In terms of clinical severity, a presenting Hunt–Hess clinical-grade I was observed in 47 (44.8%) cases, grade II in 19 (18.1%) cases, grade III in 30 (28.6%) cases, grade IV in 6 (5.6%) cases, and grade V in 3 (2.9%) cases. None of the patients showed a newly developed tirofiban-related intracerebral hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, or ventriculostomy-related hemorrhage. There were 3 (2.8%) patients who had thromboembolic complications.

Conclusions

We have determined a new protocol for prophylactic intraoperative tirofiban during the endovascular treatment of ruptured intracranial aneurysms with no oral antiplatelet medications. In our study, tirofiban showed a low risk of hemorrhagic or thromboembolic complications. Tirofiban appears to be a safe and alternative during the stent-assisted coiling of ruptured intracranial aneurysms.

中文翻译：

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静脉注射替罗非班用于支架辅助弹簧圈栓塞治疗急性颅内动脉瘤破裂的安全性和有效性：单中心经验

背景

关于替罗非班治疗颅内动脉瘤破裂的报道很少，而且结果相互矛盾。然而，替罗非班的最佳剂量和合理疗程的安全性和有效性尚未确定。

客观的

旨在确定在不使用口服抗血小板药物的情况下对颅内动脉瘤破裂进行血管内治疗期间预防性应用替罗非班的新方案的安全性和有效性。

方法

这项回顾性研究基于 2017 年 8 月至 2020 年 7 月期间在我们机构接受支架辅助弹簧圈栓塞的 105 例破裂动脉瘤患者。支架置入后，对患者静脉注射替罗非班。支架展开后立即在 3 分钟内静脉推注替罗非班 (5 µg/kg)，然后以 0.06–0.08 µg/kg/min 维持输注 12–24 小时。在停止替罗非班输注前 2 小时，双重口服抗血小板治疗与一半替罗非班剂量重叠。记录颅内出血或血栓栓塞的病例。

结果

这项研究总共纳入了 105 名颅内动脉瘤破裂患者，他们接受了支架辅助弹簧圈栓塞术。就临床严重程度而言，亨特-赫斯临床I级为47例（44.8%），II级为19例（18.1%），III级为30例（28.6%），IV级为6例（ 5.6%）例，V 级 3 例（2.9%）。没有患者出现新发生的替罗非班相关脑出血、脑室内出血、蛛网膜下腔出血或脑室造口术相关出血。有3名（2.8%）患者出现血栓栓塞并发症。

结论

我们已经确定了在颅内动脉瘤破裂的血管内治疗过程中预防性术中使用替罗非班的新方案，无需口服抗血小板药物。在我们的研究中，替罗非班显示出血或血栓栓塞并发症的风险较低。在支架辅助弹簧圈栓塞术治疗破裂的颅内动脉瘤期间，替罗非班似乎是一种安全的替代方案。