S.A. Landik, D.V. Svistov, D.V. Kandiba, A.V. Savello
Medicomilitary Academy, Saint Petersburg, Russia
The study goal has been estimation of efficacy of thrombolytic therapy in correction of complications, arising in embolizatiion of cerebral aneurysms.
Intravascular operations, made in 221 cases, caused development of thromboembolic complications in 21 of them, which demanded carrying out thrombolytic therapy. All the cases were retrospectively divided into 2 groups. Fibrinolytics and inhibitors of IIb/IIIa glycoprotein receptors (GPR) were used in the first (n=9) and second (n=12) groups, respectively. Thromboembolic complications developed intraoperatively in the majority of cases. They were not connected with technical difficulties, experienced during catheterization and embolization. Balloon-assisted embolization was more frequent in the second group. One could watch local (15), spread (1) and distal (embolism) (5) thromboses. Total occlusion of an affected segment was predominant in the second group (76.9% versus 44.4%). Thrombolysis was either isolated or combined with mechanical destruction of a thrombus.
According to the results of control examinations, complete lysis of a thrombus was achieved in 66.7% of cases of the first group and 100% of cases of the second one. There were no complications, when inhibitors of IIb/IIIa GPR were used. There was a fatal rupture of embolized aneurysm after thrombolytic therapy. Complete regression of neurological symptoms was observed in 44.4% and 83.3% of cases of the first and second groups, respectively. It happened on the first day in 9 (75%) and 3 (33.3%) cases of the second and first groups, respectively. A number of fatal outcomes in the first and second groups was 3 (33.3%) and 1 (8.3%), respectively. Life quality of survivors of the second group was much higher.
Intraoperative thromboembolic complications develop in 10% of intravascular interventions. Inhibitors of IIb/IIIa GPR are drugs of choice for thromboembolic therapy.