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Differences in thromboembolism after stent-assisted coiling for unruptured aneurysms between aspirin plus clopidogrel
Seung Hwan Kim1, Hyungon Lee2, Su Bin Kim2
1Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Insights
Aspirin plus clopidogrel showed lower postprocedure infarction rates than ticagrelor after unruptured aneurysm coiling. Aneurysm type, not just medication, significantly impacts infarction risk.
Area of Science:
- Neurology
- Cardiology
- Interventional Radiology
Background:
- Endovascular coiling for unruptured aneurysms aims to prevent thromboembolisms.
- Tailored antiplatelet therapy is crucial for managing antiplatelet resistance.
- Comparing different antiplatelet regimens is essential for optimizing patient outcomes.
Purpose of the Study:
- To compare the efficacy of aspirin plus clopidogrel versus ticagrelor in reducing procedural thromboembolisms.
- To evaluate the incidence of postprocedure infarction using diffusion-weighted imaging (DWI) after stent-assisted coiling.
- To identify factors associated with postprocedure infarction in patients undergoing endovascular aneurysm treatment.
Main Methods:
- A prospective study involving 72 patients (78 aneurysms) undergoing stent-assisted coiling.
- Patients received either aspirin plus clopidogrel (n=20) or ticagrelor (n=52) as antiplatelet preparation.
- Diffusion-weighted imaging (DWI) was performed 2 hours post-procedure to detect thromboembolic events.
Main Results:
- Postprocedure infarction was observed in 47.4% of procedures, with symptomatic infarction in 1.28%.
- The aspirin plus clopidogrel group had significantly lower postprocedure infarction rates (27.3%) compared to the ticagrelor group (55.4%, p=0.043).
- Aneurysm type and guiding catheter type were significantly associated with postprocedure infarction.
Conclusions:
- Ticagrelor use was associated with higher postprocedure infarction rates compared to aspirin plus clopidogrel after stent-assisted coiling.
- Aneurysm type appears to be a more significant factor in postprocedure infarction than the specific antiplatelet medication used.
- Further research may be needed to refine antiplatelet strategies based on individual patient and aneurysm characteristics.
Purpose:
To reduce procedural thromboembolisms, tailored antiplatelet drug preparation has been used according to antiplatelet resistance for endovascular coiling of unruptured aneurysms. We compared an aspirin plus clopidogrel group with a ticagrelor group using diffusion-weighted imaging (DWI) after stent-assisted coiling for unruptured aneurysms.
Methods:
From October 2018 to April 2019, 72 patients with 78 aneurysms underwent stent-assisted coiling, with aspirin plus clopidogrel (n = 20 patients with 22 aneurysms) or ticagrelor (n = 52 patients with 56 aneurysms) as an antiplatelet preparation, and were enrolled in our study. All patients were evaluated using DWI 2 h after coiling to detect procedural thromboembolisms.
Results:
Postprocedure infarction was observed on DWI in 37 procedures (47.4%), and symptomatic infarction occurred in 1 procedure (1.28%). Postprocedure infarction was significantly lower in the aspirin plus clopidogrel than in ticagrelor group (27.3% vs. 55.4%, p = 0.043). Postprocedure infarction was associated with aneurysm type (sidewall aneurysm (30.8%) vs. aneurysm with incorporated branches (64.1%), p = 0.006) and guiding catheter type (single (23.8%) vs. double (56.1%), p = 0.020). Multivariable logistic regression analysis demonstrated that postprocedure infarction was related to aneurysm type (adjusted odds ratio (OR); 3.317, confidence interval (CI); 1.223-8.991, p = 0.018), guiding catheter type (adjusted OR; 2.783, CI; 0.828-9.353, p = 0.098), and antiplatelet medication (adjusted OR; 1.295, CI; 0.969-1.730, p = 0.080).
Conclusions:
Postprocedure infarction was observed on DWI after stent-assisted coiling for unruptured aneurysms more frequently in the ticagrelor group than in the aspirin plus clopidogrel group. However, our study suggests that postprocedure infarction is more associated with aneurysm type than antiplatelet medication.
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