颅内未破裂动脉瘤支架辅助栓塞术后继发非动脉瘤性颅内出血的临床特征

目的 探讨颅内未破裂动脉瘤支架辅助栓塞术后继发非动脉瘤性颅内出血的临床特征。方法 回顾性分析2019年8月至2022年8月支架辅助弹簧圈栓塞治疗的67例颅内未破裂动脉瘤的临床资料。结果 术后发生非动脉瘤性颅内出血7例；其中6例出血位于动脉瘤同侧、1例对侧；3例行去骨瓣减压+颅内血肿清除术，3例保守治疗，1例行神经导航下血肿清除术；出院时改良Rankin量表评分0～2分3例，3～5分3例，死亡1例。与未发生出血病人相比，出血病人术前收缩压和术前血栓弹力图检测ADP抑制率明显增高（P<0.05）。结论 非动脉瘤性颅内出血是颅内未破裂动脉瘤支架辅助栓塞术后少见并发症，术后控制好血压、术前ADP抑制率较高病人谨慎使用抗血小板治疗有助于减少其发生率。

Clinical analysis of non-aneurysmal intracranial hemorrhage in patients with unruptured intracranial aneurysm after stent-assisted embolization

Objective To investigate the clinical characteristics of non-aneurysmal intracranial hemorrhage in patients with unruptured intracranial aneurysms after stent-assisted embolization. Methods The clinical data of 67 patients with unruptured intracranial aneurysms treated with stent-assisted coil embolization from August 2019 to August 2022 were retrospectively analyzed. Results Non-aneurysmal intracranial hemorrhage occurred in 7 patients after the operation. The location of hemorrhage was on the same side of the aneurysms in 6 patients and on the opposite side in 1 patient. Three patients underwent decompressive craniectomy and removal of hematoma, 3 received conservative treatment, and 1 underwent removal of the hematoma under neuronavigation. On discharge, a modified Rankin scale score of 0~2 was achieved in 3 patients, a score of 3~5 in 3, and 1 patient died. Compared with the patients without bleeding, the preoperative systolic blood pressure and the inhibition rate of ADP were significantly increased in the patients with bleeding (P<0.05). Conclusions Non-aneurysmal intracranial hemorrhage is a rare complication in patients with unruptured intracranial aneurysms after stent-assisted embolization, good control of postoperative blood pressure, and careful use of antiplatelet therapy in patients with high preoperative ADP inhibition rate can help reduce the incidence of non-aneurysmal intracranial hemorrhage.