支架辅助弹簧圈栓塞治疗未破裂颅内动脉瘤中的双重抗血小板治疗:替格瑞洛与氯吡格雷的比较  

Dual antiplatelet therapy in stent-assisted coil embolization of unruptured intracranial aneurysms:a comparison of ticagrelor and clopidogrel

作　　者：张朋杰 蔡菁[2] 刘于海[2] 李健 陈阳[2] 徐方迪 Zhang Pengjie;Cai Jing;Liu Yuhai;Li Jian;Chen Yang;Xu Fangdi(Weifang Medical College,Weifang 261053 China;Department of Neurosurgery,Linyi People's Hospital,Linyi 276100,China;Shandong First Medical University,Jinan 250117,China)

机构地区：[1]潍坊医学院,潍坊261053 [2]临沂市人民医院神经外科,276100 [3]山东第一医科大学,济南250117

出　　处：《国际脑血管病杂志》2023年第4期264-270,共7页International Journal of Cerebrovascular Diseases

摘　　要：目的比较双重抗血小板治疗中替格瑞洛与氯吡格雷在未破裂颅内动脉瘤支架辅助栓塞术中的安全性和有效性。方法回顾性纳入2021年1月至2022年6月在临沂市人民医院神经外科接受支架辅助栓塞治疗的未破裂颅内动脉瘤患者,根据术前双重抗血小板治疗方案分为阿司匹林+氯吡格雷组(氯吡格雷组)和阿司匹林+替格瑞洛组(替格瑞洛组)。术后随访3个月,比较氯吡格雷组和替格瑞洛组缺血事件和出血事件发生率。应用多变量logistic回归模型分析术后缺血事件和出血事件的独立危险因素。结果共纳入195例患者,年龄(58.15±10.11)岁,男性75例(38.5%)。替格瑞洛组94例,氯吡格雷组101例,两组术后3个月时的出血事件发生率(12.8%对5.9%)和缺血事件发生率(14.9%对18.8%)均差异无统计学意义。多变量logistic回归分析显示,吸烟[优势比(odds ratio,OR)6.085,95%置信区间(confidence interval,CI)1.589~13.012;P=0.019]、高血压(OR 4.547,95%CI 1.589~13.012;P=0.005)、分支血管处动脉瘤(OR 3.089,95%CI 1.122~8.504;P=0.029)以及使用血流导向装置(OR 3.111,95%CI 1.062~9.110;P=0.038)是术后缺血事件的独立危险因素;甘油三酯可能为术后出血事件的独立危险因素(OR 1.435,95%CI 0.989~2.082;P=0.057),但未达到统计学意义。结论在未破裂颅内动脉瘤支架辅助栓塞术的双重抗血小板治疗中,替格瑞洛与氯吡格雷具有相同的安全性和有效性。Objective To compare the safety and efficacy of ticagrelor and clopidogrel in dual antiplatelet therapy for stent-assisted embolization of unruptured intracranial aneurysms.Methods Patients with unruptured intracranial aneurysms received stent-assisted embolization in the Department of Neurosurgery,Linyi People's Hospital from January 2021 to June 2022 were retrospectively included.According to the preprocedural dual antiplatelet therapy scheme,they were divided into aspirin+clopidogrel group(clopidogrel group)and aspirin+ticagrelor group(ticagrelor group).The incidence of ischemic and bleeding events was compared between the clopidogrel group and the ticagrelor group at 3 months after procedure.Multivariate logistic regression model was used to analyze independent risk factors for postprocedural ischemic and bleeding events.Results A total of 195 patients were included.Their age was 58.15±10.11 years and 75 were males(38.5%).There was no statistically significant difference in the incidence of bleeding events(12.8%vs.5.9%)and ischemic events(14.9%vs.18.8%)at 3 months after procedure between the ticagrelor group(n=94)and the clopidogrel group(n=101).Multivariate logistic regression analysis showed that smoking(odds ratio[OR]6.085;95%confidence interval[CI]1.589-13.012;P=0.019),hypertension(OR 4.547,95%CI 1.589-13.012;P=0.005),aneurysm at the branch vessel(OR 3.089,95%CI 1.122-8.504;P=0.029),and the use of flow diverter(OR 3.111,95%CI 1.062-9.110;P=0.038)were the independent risk factors for postprocedural ischemic events.Triglycerides might be an independent risk factor for postprocedural bleeding events(OR 1.435,95%CI 0.989-2.082;P=0.057),but did not reach statistical significance.Conclusions In dual antiplatelet therapy for stent-assisted embolization of unruptured intracranial aneurysms,ticagrelor and clopidogrel have the same safety and efficacy.

关 键 词：颅内动脉瘤 血管内手术 栓塞 治疗性 支架 抗血小板聚集药 氯吡格雷 替格瑞洛 治疗结果 

分 类 号：R743[医药卫生—神经病学与精神病学]