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Antiplatelet therapy discontinuation after stent-assisted coil embolization for intracranial aneurysms: a

Shunsaku Goto, Takashi Izumi, Masahiro Nishihori

    Journal of Neurosurgery
    |August 6, 2022
    PubMed

    Insights

    Discontinuing single antiplatelet therapy (SAPT) after stent-assisted coil embolization (SACE) for intracranial aneurysms appears safe after two years if no complications arise. T- or Y-stent use increases risks for delayed ischemic events.

    Area of Science:

    • Neurosurgery
    • Interventional Neuroradiology
    • Vascular Neurology

    Background:

    • The optimal antiplatelet therapy protocol following stent-assisted coil embolization (SACE) for intracranial aneurysms is not well-defined.
    • Discontinuation of single antiplatelet therapy (SAPT) remains a controversial topic in managing patients post-SACE.

    Purpose of the Study:

    • To investigate the long-term outcomes associated with discontinuing SAPT after SACE.
    • To identify risk factors for antiplatelet therapy reduction or discontinuation and analyze outcomes post-discontinuation.

    Main Methods:

    • Retrospective analysis of 240 patients undergoing SACE between 2010-2020 with >1 year follow-up.
    • Evaluation of delayed ischemic and hemorrhagic complication rates, and risk factors for antiplatelet therapy modification.

    Main Results:

    • Nine (3.8%) patients experienced delayed ischemic complications; 3 (1.3%) had modified Rankin Scale score decline.
    • T- or Y-stent configuration was the sole risk factor for delayed ischemic complications (p < 0.001).
    • SAPT was discontinued in 71.7% of 205 patients with >2 years follow-up, with no observed ischemic complications.

    Conclusions:

    • Discontinuing SAPT is safe for patients without ischemic complications and with stable MRA findings 2 years post-SACE.
    • T- or Y-stent use is a significant risk factor for delayed ischemic complications, warranting cautious consideration of antiplatelet therapy reduction or discontinuation.
    Abstract

    Keywords:
    antiplatelet therapydiscontinuationintracranial aneurysmlong-term resultsstent-assisted coil embolizationvascular disorders

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