Choi Hyun Ho, Lee Heui Seung, Lee Sung Ho, Kim Kangmin, Cho Won-Sang, Kim Jeong Eun, Kang Hyun-Seung
1Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
2Department of Neurosurgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea; and.
Neurosurg Focus. 2023 Oct;55(4):E12. doi: 10.3171/2023.7.FOCUS22654.
Much emphasis has been put on the use of antiplatelet medication for the prevention of ischemic events in the treatment of cerebral aneurysms with stent assistance. In this regard, the effectiveness and safety of a low-dose prasugrel regimen during the periprocedural period was recently reported. The purpose of this study was to present the outcomes of patients on low-dose prasugrel regimens during the follow-up period after stent-assisted coil embolization (SACE) of cerebral aneurysms.
For the 396 consecutive patients undergoing SACE procedures, low-dose prasugrel therapy (5 mg of prasugrel and 100 mg of aspirin) was recommended for 3 months after the endovascular treatment. The authors performed a retrospective review of a single-center experience focusing on delayed ischemic events beyond 1 month after treatment. The mean follow-up period was 24.6 ± 11.3 months.
In this cohort of patients on a low-dose prasugrel regimen, cerebral infarction occurred in 1 patient (0.3%, 95% CI 0%-1.8%) beyond 1 month after SACE. No intracranial hemorrhage occurred. Overall ischemic events occurred in 14 patients (3.5%, 95% CI 2.1%-5.9%), all within 6 months of the coiling procedure. All patients had transient symptoms. The events occurred within 2 months after cessation of prasugrel in 11 patients (78.6%). Prasugrel maintenance for 6 months was found to result in lower ischemic events compared with maintenance for 3 months.
For patients undergoing SACE, a low-dose prasugrel regimen was a safe and reliable treatment option for the prevention of delayed ischemic events. Transient ischemic events often occurred within 2 months of stopping prasugrel medication.
在支架辅助治疗脑动脉瘤过程中，抗血小板药物在预防缺血性事件方面受到了广泛关注。近期有报道称低剂量普拉格雷方案在围手术期的有效性和安全性。本研究的目的是呈现脑动脉瘤支架辅助弹簧圈栓塞术（SACE）后随访期间接受低剂量普拉格雷方案治疗的患者的预后情况。
对于连续396例行SACE手术的患者，建议在血管内治疗结束后3个月采用低剂量普拉格雷治疗（5毫克普拉格雷和100毫克阿司匹林）。作者对单中心经验进行了回顾性分析，重点关注治疗后1个月以上的延迟性缺血事件。平均随访期为24.6±11.3个月。
在这组接受低剂量普拉格雷方案治疗的患者中，1例（0.3%，95%CI 0%-1.8%）在SACE术后1个月以上发生脑梗死。未发生颅内出血。总体缺血事件发生在14例患者中（3.5%，95%CI 2.1%-5.9%），均在弹簧圈栓塞术后6个月内。所有患者均有短暂症状。11例患者（78.6%）在停用普拉格雷后2个月内发生这些事件。发现普拉格雷维持治疗6个月比维持治疗3个月导致的缺血事件更少。
对于接受SACE的患者，低剂量普拉格雷方案是预防延迟性缺血事件的安全可靠的治疗选择。短暂性缺血事件通常在停用普拉格雷药物后2个月内发生。
