Relevance of Antiplatelet Therapy Duration After Stent-Assisted Coil Embolization for Unruptured Intracranial Aneurysms

• Published in: World neurosurgery Vol. 116; pp. e699 - e708
• Main Authors: Kim, Tackeun, Kim, Chang Hyeun, Kang, Si-Hyuck, Ban, Seung Pil, Kwon, O-Ki
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2018
• Subjects: Coil embolization; Intracranial aneurysm; Platelet inhibitor; Stent; Thromboembolism; UIA; Stent; TIA; mRS; Coil embolization; Platelet inhibitor; DTE; SAC; SAPT; Intracranial aneurysm; ETE; Thromboembolism; DAPT
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.05.071

The optimal duration of dual-antiplatelet therapy (DAPT) for preventing delayed thromboembolic events (DTEs) remains unclear. We aimed to determine whether longer DAPT provides improved protection against delayed DTEs. This retrospective cohort study included 507 stent-assisted coil embolization procedures using a single stent for unruptured intracranial aneurysms. We performed coarsened exact matching according to the duration of maintenance DAPT. DTEs were defined as any neurologic symptoms concerning the stented vascular territory and occurring at 1 month or later after the procedure. After stratification according to DAPT duration (short-term, <9 months; long-term, ≥9 months), the log-rank test and Z-analysis were performed to evaluate the efficacy of long-term DAPT for preventing DTEs. Of 507 treated patients (median follow-up, 44 months), 25 (4.9%) experienced DTEs at 1 month after the procedure. Among all DTEs, 9 (1.8%) were infarctions confirmed on magnetic resonance imaging. Permanent neurologic deficit (modified Rankin Scale score ≥2) occurred in 2 (0.4%) patients. On procedure-to-event analysis, long-term DAPT was not superior for preventing DTEs. Most events occurred within 1 month of switching from DAPT to single-antiplatelet therapy, regardless of DAPT duration. The longest time from the procedure to DTE occurrence was 22 months. Age older than 54.5 years was identified as independent risk factor for DTE-stroke. Compared with short-term DAPT, long-term DAPT delays the occurrence of DTEs but does not lower their incidence. Longer-term DAPT (>9 months) should be considered after stent-assisted coil embolization for unruptured intracranial aneurysms, although its efficacy remains to be clarified. •The optimal duration of DAPT for preventing DTEs remains unclear.•A total of 507 stent-assisted coil embolization procedures for UIAs were analyzed using coarsened exact matching.•More than half of DTEs occurred within 1 month from switching DAPT to single antiplatelet.•Compared with short-term DAPT, long-term DAPT can delay the occurrence of DTEs but does not lower their incidence.