Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
J Stroke Cerebrovasc Dis. 2013 Jul;22(5):650-5. doi: 10.1016/j.jstrokecerebrovasdis.2012.02.008. Epub 2012 Mar 21.
Although the efficacy of antiplatelet therapy for coiling of unruptured cerebral aneurysms has been reported, regimens for this therapy are not yet well established. The aim of this retrospective study was to analyze correlations among the modes of antiplatelet use, aneurysmal configuration, coiling methods, and complications to elucidate the optimal antiplatelet therapy for coiling.
The study population comprised 154 patients with unruptured aneurysms who underwent coiling with antiplatelet therapy at our institution between 2001 and 2009. The patients were categorized by mode of antiplatelet therapy (single [n = 64] or dual [n = 90]), neck size (wide [n = 80] or narrow [n = 74]), and technique used (simple [n = 42] or adjunctive [n = 112]). The incidences of hemorrhagic/ischemic complications and abnormalities on postprocedural diffusion-weighted magnetic resonance imaging (DWI) in each group were statistically assessed.
Hemorrhagic complications occurred in 1 case (1.5%) with single antiplatelet therapy and in 2 cases (2.2%) with dual antiplatelet therapy. Symptomatic ischemic complications occurred in 5 cases (7.8%) with single therapy and in 4 cases (4.4%) with dual therapy. Abnormalities were detected by DWI in 27 cases (42%) with single therapy and in 31 cases (34%) with dual therapy. No significant difference was found between modes of antiplatelet therapy even when the technique used was taken into account. In cases of wide neck, however, there were significant differences in the rate of symptomatic ischemic complications (single, 21.7%; dual, 3.5%; P = .014) and DWI abnormalities (single, 37.8%; dual, 20.9%; P = .048).
Our data suggest that dual antiplatelet therapy may better prevent ischemic complications from coiling for wide-necked aneurysms compared with single antiplatelet therapy.
尽管已有抗血小板治疗未破裂脑动脉瘤的疗效报道，但这种治疗方案尚未得到很好的确立。本回顾性研究旨在分析抗血小板使用方式、动脉瘤形态、线圈方法和并发症之间的关系，以阐明最佳的线圈抗血小板治疗方法。
本研究纳入了 2001 年至 2009 年期间在我院接受抗血小板治疗线圈治疗的 154 例未破裂动脉瘤患者。患者根据抗血小板治疗方式（单药[64 例]或双药[90 例]）、颈部大小（宽颈[80 例]或窄颈[74 例]）和使用技术（单纯[42 例]或辅助[112 例]）进行分类。统计分析了每组的出血/缺血性并发症和术后弥散加权磁共振成像（DWI）异常发生率。
单药抗血小板治疗组有 1 例（1.5%）发生出血性并发症，双药抗血小板治疗组有 2 例（2.2%）发生出血性并发症。单药治疗组有 5 例（7.8%）发生症状性缺血性并发症，双药治疗组有 4 例（4.4%）发生症状性缺血性并发症。单药治疗组有 27 例（42%）DWI 异常，双药治疗组有 31 例（34%）DWI 异常。即使考虑到使用的技术，抗血小板治疗方式之间也没有显著差异。然而，在宽颈的情况下，症状性缺血性并发症的发生率（单药，21.7%；双药，3.5%；P =.014）和 DWI 异常（单药，37.8%；双药，20.9%；P =.048）有显著差异。
我们的数据表明，与单药抗血小板治疗相比，双药抗血小板治疗可能更能预防宽颈动脉瘤线圈治疗后的缺血性并发症。
