Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
J Neurointerv Surg. 2024 Jun 17;16(7):691-697. doi: 10.1136/jnis-2023-020495.
The optimal duration of dual antiplatelet therapy (DAPT) in patients with cerebral aneurysm who undergo stent-assisted coil embolization (SACE) has not been established. We aimed to clarify the association between duration of DAPT and incidence of ischemic stroke in patients with cerebral aneurysm.
We registered patients with cerebral aneurysm who underwent SACE in 27 hospitals in Japan. Those treated with DAPT (aspirin and clopidogrel) were eligible for inclusion in a previously reported randomized control trial (RCT). Patients who were ineligible or refused to participate to the RCT were followed-up for 15 months after SACE as the non-RCT cohort. Our study examined both the RCT and non-RCT cohorts. The primary and secondary outcomes were ischemic stroke and hemorrhagic events.
Among the 313 patients registered, 296 were included for analysis (of these, 136 were RCT patients and 160 were non-RCT patients). Patients who were treated with DAPT for more than 6 months (n=191) were classified as the long-term DAPT group. Those treated less than 6 months (n=105) were classified as the short-term group. The incidence of ischemic stroke did not significantly differ between the long-term group (2.5 per 100 person-years) and the short-term group (3.2 per 100 person-years); nor did incidence of hemorrhagic events (0.8 and 3.2 per 100 person-years, respectively). The period of DAPT was not significantly associated with incidence rates of ischemic stroke or hemorrhagic events.
Duration of DAPT was not associated with the incidence of ischemic stroke in the first 15 months after SACE.
支架辅助弹簧圈栓塞术（SACE）治疗脑动脉瘤患者的双联抗血小板治疗（DAPT）的最佳持续时间尚未确定。我们旨在阐明 DAPT 持续时间与脑动脉瘤患者缺血性卒中发生率之间的关系。
我们在日本的 27 家医院登记了接受 SACE 的脑动脉瘤患者。接受 DAPT（阿司匹林和氯吡格雷）治疗的患者有资格参加先前报道的随机对照试验（RCT）。不符合条件或拒绝参加 RCT 的患者在 SACE 后 15 个月作为非 RCT 队列进行随访。我们的研究检查了 RCT 和非 RCT 队列。主要和次要结局是缺血性卒中和出血事件。
在登记的 313 名患者中，有 296 名被纳入分析（其中 136 名是 RCT 患者，160 名是非 RCT 患者）。接受 DAPT 治疗超过 6 个月的患者（n=191）被归类为长期 DAPT 组。接受少于 6 个月治疗的患者（n=105）被归类为短期组。长期组（每 100 人年 2.5 例）和短期组（每 100 人年 3.2 例）的缺血性卒中发生率无显著差异；出血事件的发生率也没有差异（分别为每 100 人年 0.8 和 3.2 例）。DAPT 期间与缺血性卒中和出血事件的发生率均无显著相关性。
在 SACE 后 15 个月内，DAPT 的持续时间与缺血性卒中的发生率无关。
