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Safety of antiplatelet medication discontinuation more than 12 months after stent-assisted coil embolization: a
Chang Hyeun Kim1, Young Hoon Choi2, Jae Sang Oh3
1Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea (the Republic of).
Insights
Discontinuing antiplatelet medication more than 12 months after stent-assisted coiling (SAC) appears safe for patients not at high risk for ischemia. This study investigated outcomes following antiplatelet medication discontinuation (AMD) in a large patient cohort.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Neuroradiology
Background:
- Antiplatelet therapy is crucial after stent-assisted coiling (SAC) to prevent ischemic events.
- The optimal timing for discontinuing antiplatelet medication (AMD) post-SAC remains unclear and debated.
- This study addresses the safety of AMD initiated over 12 months after SAC procedures.
Purpose of the Study:
- To evaluate the safety of antiplatelet medication discontinuation (AMD) in patients more than 12 months after stent-assisted coiling (SAC).
- To analyze clinical outcomes following delayed AMD in a diverse patient population.
Main Methods:
- A multicenter, prospective, non-interventional study involving 495 patients who underwent AMD >12 months post-SAC.
- Data collected from January 2021 to December 2023, with a minimum 6-month follow-up post-AMD.
- Physician discretion guided maintenance duration and cessation based on patient clinical status.
Main Results:
- No ischemic events were observed in relation to AMD, even in the 41.0% of patients considered high-risk.
- The mean time to AMD was 20.0±12.9 months after SAC.
- Internal carotid artery aneurysms were most commonly treated (67.1%), with open-cell laser-cut stents being prevalent (60.5%).
Conclusions:
- Antiplatelet medication discontinuation over 12 months after SAC is a safe strategy for patients not at high risk for ischemia.
- Further confirmation through randomized controlled trials is recommended to solidify these findings.
Background:
Antiplatelet maintenance is essential to avoid ischemia following stent-assisted coiling (SAC) procedures. However, indications for antiplatelet medication discontinuation (AMD) remain controversial, and optimal timing of cessation has yet to be determined. Our goal, which we achieved through a multicenter, prospectively enrolled, non-interventional study, was to investigate the safety of AMD conducted more than 12 months after SAC.
Methods:
Data were retrieved from the records of 495 consecutive patients prospectively enrolled at 10 institutions during a 3-year period (between January 2021 and December 2023). Each subject had discontinued antiplatelet therapy >12 months after SAC. Maintenance duration and cessation were both at physician discretion, based on patient clinical status. We investigated clinical outcomes for at least 6 months after AMD.
Results:
A majority of patients engaged in AMD (292/495, 59.0%) were not at high risk for ischemia. Mean±SD time to AMD was 20.0±12.9 months after SAC. Treated aneurysms were largely confined to the internal carotid artery (332/495, 67.1%), followed by the anterior (95/495, 19.2%) and middle (43/495, 8.7%) cerebral arteries. A laser-cut open-cell stent was most often applied (60.5%); laser-cut closed-cell (22.2%) and braided closed-cell (17.3%) stents were used to a lesser extent. Four patients underwent double stenting. Despite sizeable (41.0%) high-risk group representation, there were no ischemic events in relation to AMD.
Conclusion:
Our results suggest that AMD >12 months after SAC procedures is safe in patients who are not at high risk for ischemia. Randomized controlled trials are warranted to confirm these results.
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