Page 184 - 北京京煤集团总医院第十一届·2023学术年会论文集

北京京煤集团总医院 第十一届·2023 学术年会论文集

基底动脉支架植入术围术期脑出血一例分析

杨辉，马宗谦，朴永军，朱维胜（北京京煤集团总医院神经外科，北京 102300）

通讯作者：朱维胜，Email：yangyao799@sohu.com
【摘要】颅内支架植入术围术期并发致死性脑出血往往会带来灾难性的后果。支架植入术

后通常给予抗栓治疗，患者凝血功能障碍，此时并发脑出血则血肿更易扩大，术中止血更
加困难，术后复发出血风险更高，为了降低上述风险需要逆转凝血功能，但这却增加了支

架堵塞的几率。在抢救性治疗过程中既要避免复发出血又要保证支架通畅，因此把握最佳
的重启抗栓时机成为治疗的关键。笔者将 1 例基底动脉支架植入术围术期并发非靶血管区

域致死性出血救治失败的病例进行报道，以期为此类病例的救治提供借鉴。

【关键词】颅内支架；围术期；脑出血；抗栓治疗
Perioperative cerebral hemorrhage after basilar artery stenting: a case report
Yang Hui, Ma Zongqian, Piao Yongjun, Zhu Weisheng
Department of Neurosurgery,Beijing Jingmei Group General Hospital,Beijing,102300,China

Corresponding author: Zhu Weisheng, Email：yangyao799@sohu.com
[Abstract] Fatal cerebral hemorrhage during the perioperative period of intracranial stent

implantation often brings catastrophic consequences. Antithrombotic therapy is usually given after
stent implantation, and patients have coagulation dysfunction. At this time, if the patient has cerebral
hemorrhage, the hematoma is more likely to expand, the intraoperative hemostasis is more difficult,
and the risk of postoperative recurrent bleeding is higher. In order to reduce the above risk, it is

necessary to reverse coagulation function, but it increases the chance of stent blockage. In the
process of rescue treatment, it is necessary to avoid recurrent bleeding and ensure the patency of the
stent, so grasping the best time to restart antithrombotic therapy has become the key to treatment.
The authors report a case of fatal hemorrhage in the non-target vessel area during the perioperative

period of basilar artery stent implantation, in order to provide a reference for the treatment of such
cases.
[Key words]intracranial stent; perioperative; cerebral hemorrhage; Antithrombotic therapy
Conflicts of interest: None declared

近年来，卒中的发病率逐年升高并成为我国居民常见的死亡病因 [1-4] ，其中又以缺血性
脑卒中占大多数 [5-6] 。颅内血管狭窄是缺血性脑卒中的常见原因，支架植入则是其主要的治

疗措施，可有效改善患者的神经功能，降低致死致残率以及卒中复发的风险。支架植入术
后往往给予抗栓治疗，以降低支架堵塞的风险，但这给术后并发颅内出血的治疗带来严峻

挑战。笔者将一例基底动脉支架植入术后并发右侧颞叶出血救治失败的病例进行如下分

析。
一、病情简介

患者女性，73 岁，主因“头晕加重伴乏力 1 天余”于 2023 年 4 月 10 日以“脑梗死”入住

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