依替巴肽治疗Pipeline密网支架置入后急性血栓形成的剂量策略

目的探讨依替巴肽治疗Pipeline置入后急性血栓形成的剂量选择和疗效观察。 方法回顾性收集南方医科大学南方医院神经外科自2018年6月至2019年6月使用依替巴肽治疗脑动脉瘤后急性血栓形成的患者临床资料。通过即刻脑血管造影（DSA）、血流灌注（TICI）分级、改良Rankin评分量表（mRs）和美国国立卫生研究院卒中量表（NIHSS）评分判断患者的治疗效果并初步探讨依替巴肽的适宜治疗剂量。 结果12例患者在置入Pipeline治疗过程中发现有程序内血栓栓塞并发症，通过依替巴肽治疗后，10例患者TICI Ⅲ级，mRs和NIHSS评分0分，1例患者TICI Ⅱa级，mRs和NIHSS评分1分，1例患者TICI Ⅱb级，mRs和NIHSS评分1分。 结论依替巴肽是治疗Pipeline置入过程中急性程序内血栓栓塞并发症的一种有效、安全的抢救策略。采用0.2 mg/kg术中单次推注或术后0.5 μg/（kg·min）维持输注的剂量策略可提供较高的血管再通率，出血并发症发生率较低，患者预后较好。

Treatment of acute thromboembolic complications after Pipeline dense mesh stent implantation with eptifibatide

ObjectiveTo investigate the dose selection and efficacy of eptifibatide in the treatment of acute thrombosis after Pipeline implantation. MethodsThe clinical data of patients with acute thrombosis after cerebral aneurysm treated with eptifibatide in the Department of Neurosurgery, Nanfang Hospital of Southern Medical University from June 2018 to June 2019 were collected retrospectively. The therapeutic effect of patients was evaluated by immediate cerebral angiography DSA, perfusion thrombolysis in cerebral infarction (TICI) grade, modified Rankin scale (mRs) score and National Institutes of Health stroke scale (NIHSS) score, and the appropriate therapeutic dose of eptifibatide was studied. ResultsThromboembolism complications were found in 12 patients during the treatment of Pipeline. After the treatment with eptifibatide, 10 patients had TICI grade Ⅲ, mRs and NIHSS score 0, 1 patient TICI Ⅱa, mRs and NIHSS score 1, and the other 1 patient TICI Ⅱb, mRs and NIHSS score 1. ConclusionEptifibatide is an effective and safe rescue strategy for acute intraprocedural thromboembolism during Pipeline implantation. The dose strategy of 0.2 mg/kg intraoperative single injection or postoperative 0.5 μg/(kg·min) maintenance infusion can provide higher recanalization rate, lower incidence of bleeding complications and better prognosis.