使用带护盾技术的Pipeline栓塞装置Flex治疗颅内动脉瘤患者时，双联抗血小板治疗的早期终止与标准疗程持续时间对比：美国3个中心的初步经验

Early Termination versus Standard Regimen Duration of Dual Antiplatelet Therapy in Intracranial Aneurysm Patients Treated With Pipeline Embolization Device Flex With Shield Technology: Preliminary Experience of 3 U.S. Centers.

作者信息

Lim Jaims, Monteiro Andre, Cortez Gustavo M, Benalia Victor H, Baig Ammad A, Jacoby Wady T, Donnelly Brianna M, Levy Bennett R, Jaikumar Vinay, Davies Jason M, Snyder Kenneth V, Siddiqui Adnan H, Hanel Ricardo A, Levy Elad I, Vakharia Kunal

机构信息

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.

Baptist Health Downtown and Lyerly Neurosurgery, Jacksonville, Florida, USA.

出版信息

World Neurosurg. 2023 Oct;178:e465-e471. doi: 10.1016/j.wneu.2023.07.101. Epub 2023 Jul 27.

DOI:10.1016/j.wneu.2023.07.101

PMID:37506841

Abstract

BACKGROUND

Pipeline Flex Embolization Device with Shield Technology (PED-Shield) is a third-generation flow diverter with reduced thromboembolic potential. However, safety profile and dual antiplatelet therapy (DAPT) recommendations with PED-Shield is not well -established. We aim to assess the safety and complication profile with early termination of DAPT with use of PED-Shield.

METHODS

Databases of 3 high-volume cerebrovascular centers were retrospectively reviewed. We identified patients with unruptured and ruptured intracranial aneurysms treated with PED-Shield. Patient demographics, aneurysm characteristics, complications, and angiographic outcomes were extracted. All patients who had early termination of DAPT, defined as <180 days, as well as standard duration were included.

RESULTS

A total of 37 patients, totaling 37 aneurysms, had early termination of DAPT and 24 patients with 24 aneurysms received standard duration (>180 days) of DAPT. There was no difference in pre-procedural DAPT regimens between the groups (P = 0.503). Following DAPT termination, o1ne major thromboembolic complication was observed in the early termination group while no major or minor thromboembolic or hemorrhagic complication was noted in the standard duration group. Time of angiographic follow-up was not statistically different (P = 0.063) between the early termination (343 days, interquartile range [IQR] 114-371 days) and the standard duration (175 days, IQR 111-224.5 days) groups. There were no statistically significant differences in complete aneurysm occlusion (P = 0.857), residual neck (P = 0.582), and aneurysm remnant (P = 0.352) rates between the groups on angiography.

CONCLUSIONS

Early termination of DAPT proves safe after PED-Shield treatment of intracranial aneurysms with comparable complete occlusion rates.

摘要

背景

带屏蔽技术的管道可弯曲栓塞装置（PED-Shield）是一种血栓栓塞风险降低的第三代血流导向装置。然而，PED-Shield的安全性及双联抗血小板治疗（DAPT）建议尚未完全确立。我们旨在评估使用PED-Shield并提前终止DAPT的安全性和并发症情况。

方法

回顾性分析3家大型脑血管中心的数据库。我们纳入了接受PED-Shield治疗的未破裂和破裂颅内动脉瘤患者。提取患者的人口统计学资料、动脉瘤特征、并发症及血管造影结果。纳入所有提前终止DAPT（定义为<180天）以及接受标准疗程DAPT的患者。

结果

共有37例患者（37个动脉瘤）提前终止DAPT，24例患者（24个动脉瘤）接受标准疗程（>180天）的DAPT。两组术前DAPT方案无差异（P = 0.503）。DAPT终止后，提前终止组观察到1例主要血栓栓塞并发症，而标准疗程组未观察到任何主要或次要血栓栓塞或出血并发症。提前终止组（343天，四分位间距[IQR] 114 - 371天）与标准疗程组（175天，IQR 111 - 224.5天）的血管造影随访时间无统计学差异（P = 0.063）。血管造影显示，两组间动脉瘤完全闭塞率（P = 0.857）、残余颈部（P = 0.582）及动脉瘤残留率（P = 0.352）无统计学差异。