Impact of duration of dual anti-platelet therapy on risk of complications after stent-assisted coiling of unruptured aneurysms

Andrew J. Ringer, Mayfield Clinic, Cincinnati, Ohio, USA editor@mayfieldclinic.com.
Ricardo A. Hanel, Department of Neurosurgery, Lyerly Neurosurgery, Baptist Health, Jacksonville, FL, USA.
Ammad A. Baig, Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA.
Adnan H. Siddiqui, Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Demetrius Klee Lopes, Advocate Health - MidwestFollow
Guilherme Barros, Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
David I. Bass, Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
Michael R. Levitt, Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
Christopher C. Young, Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
Ryan M. Naylor, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Giuseppe Lanzino, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
R Webster Crowley, Neurosurgery, Rush University, Chicago, Illinois, USA.
Joseph C. Serrone, Department of Neurological Surgery, Loyola University, Maywood, IL, USA.
Peter T. Kan, Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
Mandy J. Binning, Global Neuroscience Institute, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Erol Veznedaroglu, Global Neuroscience Institute, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Alan Boulos, Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.
Rabih Tawk, Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA.

Affiliations

Brain and Spine Institute, Park Ridge

Abstract

Background:The optimal duration for dual antiplatelet therapy (DAPT) after stent-assisted coiling (SAC) of intracranial aneurysms is unclear. Longer-term therapy may reduce thrombotic complications but increase the risk of bleeding complications.

Methods:A retrospective review of prospectively maintained data at 12 institutions was conducted on patients with unruptured intracranial aneurysms who underwent SAC between January 1, 2016 and December 31, 2020, and were followed ≥6 months postprocedure. The type and duration of DAPT, stent(s) used, outcome, length of follow-up, complication rates, and incidence of significant in-stent stenosis (ISS) were collected.

Results:Of 556 patients reviewed, 450 met all inclusion criteria. Nine patients treated with DAPT <29 days after SAC and 11 treated for 43-89 days were excluded from the final analysis as none completed their prescribed duration of treatment. Eighty patients received short-term DAPT. There were no significant differences in the rate of thrombotic complications during predefined periods of risk in the short, medium, or long-term treatment groups (1/80, 1.3%; 2/188, 1.1%; and 0/162, 0%, respectively). Similarly, no differences were found in the rate of hemorrhagic complications during period of risk in any group (0/80, 0%; 3/188, 1.6%; and 1/162, 0.6%, respectively). Longer duration DAPT did not reduce ISS risk in any group.

Conclusions:Continuing DAPT >42 days after SAC did not reduce the risk of thrombotic complications or in-stent stenosis, although the risk of additional hemorrhagic complications remained low. It may be reasonable to discontinue DAPT after 42 days following non-flow diverting SAC of unruptured intracranial aneurysms.

Document Type

Article

PubMed ID

39137967

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