Kim Tackeun, Kim Chang Hyeun, Kang Si-Hyuck, Ban Seung Pil, Kwon O-Ki
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
World Neurosurg. 2018 Aug;116:e699-e708. doi: 10.1016/j.wneu.2018.05.071. Epub 2018 May 17.
The optimal duration of dual-antiplatelet therapy (DAPT) for preventing delayed thromboembolic events (DTEs) remains unclear. We aimed to determine whether longer DAPT provides improved protection against delayed DTEs.
This retrospective cohort study included 507 stent-assisted coil embolization procedures using a single stent for unruptured intracranial aneurysms. We performed coarsened exact matching according to the duration of maintenance DAPT. DTEs were defined as any neurologic symptoms concerning the stented vascular territory and occurring at 1 month or later after the procedure. After stratification according to DAPT duration (short-term, <9 months; long-term, ≥9 months), the log-rank test and Z-analysis were performed to evaluate the efficacy of long-term DAPT for preventing DTEs.
Of 507 treated patients (median follow-up, 44 months), 25 (4.9%) experienced DTEs at 1 month after the procedure. Among all DTEs, 9 (1.8%) were infarctions confirmed on magnetic resonance imaging. Permanent neurologic deficit (modified Rankin Scale score ≥2) occurred in 2 (0.4%) patients. On procedure-to-event analysis, long-term DAPT was not superior for preventing DTEs. Most events occurred within 1 month of switching from DAPT to single-antiplatelet therapy, regardless of DAPT duration. The longest time from the procedure to DTE occurrence was 22 months. Age older than 54.5 years was identified as independent risk factor for DTE-stroke.
Compared with short-term DAPT, long-term DAPT delays the occurrence of DTEs but does not lower their incidence. Longer-term DAPT (>9 months) should be considered after stent-assisted coil embolization for unruptured intracranial aneurysms, although its efficacy remains to be clarified.
双联抗血小板治疗（DAPT）预防延迟性血栓栓塞事件（DTEs）的最佳疗程仍不明确。我们旨在确定更长疗程的DAPT是否能更好地预防延迟性DTEs。
这项回顾性队列研究纳入了507例使用单个支架辅助弹簧圈栓塞术治疗未破裂颅内动脉瘤的病例。我们根据维持DAPT的疗程进行了精确匹配。DTEs定义为与支架置入血管区域相关的任何神经症状，且在术后1个月或更晚出现。根据DAPT疗程分层（短期，<9个月；长期，≥9个月）后，采用对数秩检验和Z分析评估长期DAPT预防DTEs的疗效。
在507例接受治疗的患者中（中位随访时间44个月），25例（4.9%）在术后1个月出现DTEs。在所有DTEs中，9例（1.8%）经磁共振成像证实为梗死。2例（0.4%）患者出现永久性神经功能缺损（改良Rankin量表评分≥2）。在手术至事件分析中，长期DAPT在预防DTEs方面并不优于短期DAPT。大多数事件发生在从DAPT转换为单药抗血小板治疗后的1个月内，与DAPT疗程无关。从手术到发生DTEs的最长时间为22个月。年龄大于54.5岁被确定为DTE-卒中的独立危险因素。
与短期DAPT相比，长期DAPT可延迟DTEs的发生，但不能降低其发生率。对于未破裂颅内动脉瘤支架辅助弹簧圈栓塞术后，应考虑采用更长疗程（>9个月）的DAPT，尽管其疗效仍有待明确。
