Safety of discontinuing antiplatelet therapy 12-24 months after stent-assisted coil embolization: a multicenter retrospective study

被引:4
|
作者
Kim, Chang Hyeun [1 ]
Hong, Noah [2 ]
Rhim, Jong-Kook [3 ]
Mun, Jong Hyeon [4 ]
Lim, Jeongwook [5 ]
Choi, Hyun Ho [6 ]
Kim, Young Ha [1 ]
Lee, Sang Weon [1 ]
Cho, Young Dae [7 ,8 ]
机构
[1] Pusan Natl Univ, Yangsan Hosp, Sch Med, Dept Neurosurg, Yangsan, South Korea
[2] Seoul Natl Univ, Coll Med, Boramae Med Ctr, Dept Neurosurg,Seoul Metropolitan Govt, Seoul, South Korea
[3] Jeju Natl Univ, Jeju Natl Univ Hosp, Coll Med, Dept Neurosurg, Seoul, South Korea
[4] Kwangju Christian Hosp, Dept Neurosurg, Gwangju, South Korea
[5] Chungnam Natl Univ, Sejong Hosp, Sch Med, Dept Neurosurg, Daejeon, South Korea
[6] Chung Ang Univ, Chung Ang Univ Hosp, Coll Med, Dept Neurosurg, Seoul, South Korea
[7] Seoul Natl Univ, Seoul Natl Univ Hosp, Coll Med, Dept Radiol, Seoul, South Korea
[8] Seoul Natl Univ, Coll Med, Seoul, South Korea
关键词
aneurysm; coil; embolization; stent; antiplatelet; vascular disorders; INTRACRANIAL ANEURYSMS;
D O I
10.3171/2023.3.JNS222177
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE Antiplatelet medication is required after stent-assisted coil embolization (SACE) to avoid thromboembolic complications. Currently, there is no consensus on how long the antiplatelet agent should be maintained. The authors investigated clinical outcomes in patients who discontinued their antiplatelet agent 12-24 months after SACE. METHODS Data were retrieved from a prospective database for 373 consecutive patients with SACE at 6 institutions who discontinued antiplatelet therapy 12-24 months after SACE. Thromboembolic complications associated with discontinuation were defined as neurological or radiographic ischemia that occurred within 6 months after discontinuation of the antiplatelet agent; the lesion had to be correlated with the territory of the stented artery. RESULTS The mean time until discontinuation of the antiplatelet medication was 15.8 +/- 4.7 months after SACE (12-18 months, n = 271; 19-24 months, n = 102). The most common location of treated aneurysms was the internal carotid artery (n = 223, 59.8%). A laser-cut open-cell stent was most commonly applied (n = 236/388, 60.8%), followed by lasercut closed-cell stents (n = 119, 30.7%) and braided closed-cell (n = 33, 8.5%); double stenting was applied in 15 aneurysms. There were no patients who experienced cerebral ischemia related to discontinuation of antiplatelet medications, except for 1 patient at high risk of ischemia (0.27%, 95% CI 0.01%-1.48%). CONCLUSIONS These results suggest that it may be safe to discontinue antiplatelet medication after SACE in patients at low risk for ischemia, and that it appears safe to discontinue the agent at approximately 15 months after the procedure. Large cohort-based prospective studies or randomized clinical trials are warranted to confirm these results.
引用
收藏
页码:1311 / 1316
页数:6
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